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Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS
19120 Removal of growth and tissue of breast, duct, or nipple CPT · Breast procedure
Classification Procedure Breast Breast Biopsy (CMS RBCS)
First observed 2013 — start of our 12-year window; the code predates it
National scale 380 services ▼ 12.2% YoY · 367 beneficiaries (CY2024, Medicare FFS)
Medicare paid $193K · $508.20 avg / service, national
CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window
Billing groups
8
Named-group FFS services
195
FFS of Medicare
49%
Services YoY
-12.2%
FFS enrollment -2.2%
Estimated all-Medicare volume FFS + estimated MA estimate
~394 services

195 observed fee-for-service (49%) · ~199 estimated Medicare Advantage. Scaled from the observed floor by each state’s fee-for-service share (FFS share as of 2024) — scaled estimate — assumes MA utilization mirrors FFS; not an observation. How we scale

Top states — 19120 (CY2024)

Disclosed Medicare fee-for-service services by billing state; open a bar for that state's ranked market.

Named-group submitted charges
$244K
Named-group allowed amount
$76K
Named-group Medicare payments
$60K
Avg charge / svc
$1,249
Avg allowed / svc
$391
Avg payment / svc
$308
Average charge per group
$999 8 groups · avg submitted charge / service $1,705
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Data year: CY2024 CY2023 CY2022 locked column CY2021 locked column CY2020 locked column
Physician groups ranked by 19120 services, highest first, CY2024
# Physician group activate to sort City activate to sort St activate to sort Specialty activate to sort Providers activate to sort 19120 svcs sorted descending — activate to reverse Submitted charges activate to sort Avg charge activate to sort Medicare $ locked column Share* activate to sort Phone
1 KATHLEEN VINE MD PC NEW YORK NY PHYSICIAN ASSISTANT 10 48 $48,000 $1,000 premium 100.0% (646) 421-6064
2 SMH PHYSICIAN SERVICES INC SARASOTA FL PHYSICIAN ASSISTANT 766 44 $43,956 $999 premium 100.0%
3 CENTRAL ARKANSAS RADIATION THERAPY INSTITUTE INC LITTLE ROCK AR HEMATOLOGY/ONCOLOGY 90 30 $51,138 $1,705 premium 26.3%
4 CEDAR VALLEY MEDICAL SPECIALISTS PC WATERLOO IA NURSE PRACTITIONER 83 22 $27,900 $1,268 premium 100.0%
5 LCMS SURGICAL ASSOCIATES OF SOUTHWEST LOUSIANA, LLC LAKE CHARLES LA GENERAL SURGERY 6 15 $24,180 $1,612 premium 100.0% (337) 494-4868
6 UKIAH ADVENTIST HOSPITAL UKIAH CA CLINICAL SOCIAL WORKER 133 14 $21,294 $1,521 premium 17.5% (707) 462-3111
7 HEALTH CARE AUTHORITY FOR BAPTIST HEALTH, AN AFFILIATE OF UABHS MONTGOMERY VA NURSE PRACTITIONER 259 11 $14,990 $1,363 premium 100.0% (334) 747-8970
8 LEHIGH VALLEY PHYSICIAN GROUP ALLENTOWN PA PHYSICIAN ASSISTANT 2389 11 $12,072 $1,098 premium 100.0%

*Share of the state's disclosed Medicare-FFS services for the primary code, counted once per clinician. "St" is the state the volume was billed from: a group appears in each state where its clinicians bill Medicare, with that state's volume and share ("City" is the group's registered location). Group figures sum clinicians affiliated with exactly one group; clinicians in several groups are listed in each group's drill-down but not volume-attributed to any single group, so shares reflect attributable volume. See Methods.

Comparing against an all-payer estimate?

These are exact counts from Medicare fee-for-service claims — roughly a third to half of most procedure markets, depending on payer mix. Modeled all-payer databases project the remainder statistically; we publish the audited floor and label it as such. Same market, different denominator. How the numbers reconcile →