NEVVI Medicare utilization intelligence
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Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS
26990 Drainage of deep abscess or blood accumulation of pelvis or hip near joint CPT · Musculoskeletal procedure
Classification Procedure › Musculoskeletal (CMS RBCS)
First observed 2013 — start of our 12-year window; the code predates it
National scale 493 services ▲ 50.8% YoY · 444 beneficiaries (CY2024, Medicare FFS)
Medicare paid $170K · $345.50 avg / service, national
CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window
Billing groups

7

Named groups billing this code
Named-group FFS services

211

Attributable volume · fee-for-service
FFS of Medicare

49%

Payer-mix frame
Services · year over year
Services YoY

+50.8%

FFS enrollment -2.2%
Volume, not care. A shrinking fee-for-service denominator is not a shrinking market.
Estimated all-Medicare volume estimate
FFS + estimated MA

~441 services

211 observed fee-for-service (48%) · ~230 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 — 26990 (CY2024)
TX 308 CA 83 NJ 74 IL 16 AR 12

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

Billed → allowed → paid
Named-group submitted charges
$367K
Named-group allowed amount
$75K
Named-group Medicare payments
$60K
Avg charge / svc
$1,739
Avg allowed / svc
$356
Avg payment / svc
$283
Totals are named-group (attributable) sums. Allowed is Medicare’s fee-schedule recognized price — what CMS recognizes, before the 80% Medicare pays.
Average charge per group
$1,200 7 groups · avg submitted charge / service $2,190
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Data year: CY2024 CY2023 CY2022  CY2021  CY2020 
# Physician group City St Specialty Providers 26990 svcs Submitted charges Avg charge Medicare $ Share* Phone
1 ORTHOLONESTAR PLLC DALLAS TX PHYSICIAN ASSISTANT 407 97 $200,887 $2,071 31.5% (214) 220-2468
2 ELI AHDOOT DO INC BURBANK CA ORTHOPEDIC SURGERY 3 45 $54,000 $1,200 54.2% (310) 526-7144
3 TEXAS JOINT INSTITUTE, PLLC DALLAS TX PHYSICIAN ASSISTANT 39 17 $37,235 $2,190 5.5% (972) 566-5255
4 HUNTINGTON ORTHOPEDIC SURGICAL GROUP PASADENA CA ORTHOPEDIC SURGERY 18 16 $25,600 $1,600 19.3% (626) 795-0282
5 JOINT PAIN AND ORTHOPEDICS, PLLC AUSTIN TX ORTHOPEDIC SURGERY 10 13 $20,670 $1,590 4.2% (512) 266-3377
6 REGIONAL ORTHOPAEDIC HEALTH CARE MOUNTAIN HOME AR ORTHOPEDIC SURGERY 5 12 $14,616 $1,218 100.0% 8704243400306
7 RAMIN GANJIANPOUR MD INC MISSION HILLS CA PHYSICIAN ASSISTANT 4 11 $13,816 $1,256 13.3% (818) 361-0136

*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 →