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Market snapshot

19318 nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS

19318 — Breast reduction

Billing groups
18
Named-group FFS services
286
FFS of Medicare
49%
Services YoY
-32.1%
FFS enrollment -2.2%
Estimated all-Medicare volume FFS + estimated MA estimate
~519 services

286 observed fee-for-service (55%) · ~233 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 — 19318 (CY2024)

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

Named-group submitted charges
$1.4M
Named-group allowed amount
$377K
Named-group Medicare payments
$300K
Avg charge / svc
$4,891
Avg allowed / svc
$1,319
Avg payment / svc
$1,049
Average charge per group
$875 18 groups · avg submitted charge / service $9,000
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Data year: CY2024 CY2023 CY2022 🔒 CY2021 🔒 CY2020 🔒
Physician groups ranked by 19318 services, CY2024
#Physician group City St Specialty Providers 19318 svcs Submitted charges Avg charge Medicare $ locked column Share* Phone
1 RIVER OAKS MANAGEMENT COMPANY LLC FLOWOOD MS NURSE PRACTITIONER 39 28 $177,996 $6,357 premium 44.4% (601) 376-1394
2 AVERA MCKENNAN SIOUX FALLS SD NURSE PRACTITIONER 964 26 $22,755 $875 premium 100.0% (605) 322-5180
3 EPIC CARE PLEASANT HILL CA HEMATOLOGY/ONCOLOGY 54 19 $70,735 $3,723 premium 18.4% (925) 687-2570
4 UNIVERSITY OF MARYLAND SURGICAL ASSOCIATES PA BALTIMORE MD GENERAL SURGERY 101 19 $108,720 $5,722 premium 63.3% (410) 328-5191
5 MERCY CLINIC OKLAHOMA COMMUNITIES OKLAHOMA CITY OK PHYSICIAN ASSISTANT 642 18 $56,992 $3,166 premium 60.0% (405) 254-9690
6 SOUTHERN INDIANA AESTHETIC AND PLASTIC SURGERY LLC COLUMBUS IN PLASTIC AND RECONSTRUCTIVE SURGERY 2 17 $78,907 $4,642 premium 28.3% (812) 376-8997
7 LONG ISLAND PLASTIC SURGICAL GROUP, PC GARDEN CITY NY PLASTIC AND RECONSTRUCTIVE SURGERY 41 17 $27,218 $1,601 premium 100.0% (516) 629-3838
8 PROVIDENCE SAINT JOHNS MEDICAL FOUNDATION SANTA MONICA CA PHYSICIAN ASSISTANT 287 17 $114,962 $6,762 premium 16.5% (310) 829-6789
9 MEDSTAR MEDICAL GROUP II LLC WASHINGTON DC PHYSICIAN ASSISTANT 3707 16 $70,000 $4,375 premium 100.0% (202) 429-2401
10 SUTTER BAY MEDICAL FOUNDATION PALO ALTO CA INTERNAL MEDICINE 3716 14 $118,100 $8,436 premium 13.6% (415) 600-1020
11 UCSF DEPT OF SURGERY SAN FRANCISCO CA GENERAL SURGERY 212 13 $116,998 $9,000 premium 12.6% (415) 476-1000
12 THE PLASTIC SURGERY GROUP OF MEMPHIS P.C. MEMPHIS TN PLASTIC AND RECONSTRUCTIVE SURGERY 7 13 $59,500 $4,577 premium 100.0% (901) 761-9030
13 AHS OKLAHOMA PHYSICIAN GROUP LLC TULSA OK FAMILY PRACTICE 308 12 $46,720 $3,893 premium 40.0%
14 BRIGHAM AND WOMENS PHYSICIANS ORGANIZATION INC BOSTON MA PHYSICIAN ASSISTANT 2942 12 $83,408 $6,951 premium 100.0% (617) 732-5500
15 GARDNER PLASTIC SURGERY INC NAPLES FL PLASTIC AND RECONSTRUCTIVE SURGERY 4 12 $65,000 $5,417 premium 40.0% (239) 566-2611
16 ST PAUL PLACE SPECIALISTS, INC. BALTIMORE VA PHYSICIAN ASSISTANT 337 11 $70,300 $6,391 premium 50.0% (410) 663-8100
17 MAGEE-ROSENBLUM PLASTIC SURGERY, INC VIRGINIA BEACH VA PLASTIC AND RECONSTRUCTIVE SURGERY 2 11 $49,800 $4,527 premium 50.0% (757) 496-5556
18 ATLANTA PLASTIC AND RECONSTRUCTIVE SPECIALISTS, LLC ALPHARETTA GA GENERAL SURGERY 5 11 $60,819 $5,529 premium 100.0% (404) 255-2975

*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 →