NEVVI Medicare utilization intelligence
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Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS
49659 Other repair of hernia using an endoscope CPT · Procedure
Classification Procedure › Digestive/Gastrointestinal › Hernia Repair - Laparoscopic (any site) (CMS RBCS)
First observed 2013 — start of our 12-year window; the code predates it
National scale 540 services · est. ▲ 205.4% YoY · 239 FFS beneficiaries (CY2024, all-Medicare estimate) — 259 observed fee-for-service services
Medicare paid $383K · est. · $696.55 avg / service, national — $180K observed FFS
CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window
Billing groups

9

Named groups billing this code
Named-group all-Medicare svcs · est.

510

Scaled from 245 observed FFS services.
FFS of Medicare

49%

Payer-mix frame
Services · year over year
Services YoY

+205.1%

All-Medicare est. · observed FFS +184.6%
Volume, not care. A shrinking fee-for-service denominator is not a shrinking market.
Estimated all-Medicare volume estimate
FFS + estimated MA

~510 services

245 observed fee-for-service (48%) · ~265 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 — 49659 (CY2024)
NM 177 TX 90 AL 79 IL 35 PA 30

Est. all-Medicare services by billing state (scaled estimate — assumes MA utilization mirrors FFS); open a bar for that state's ranked market.

Billed → allowed → paid
Named-group submitted charges
$1.6M
Named-group allowed amount
$216K
Named-group Medicare payments
$366K · est.
— $172K observed FFS
Avg charge / svc
$6,340
Avg allowed / svc
$880
Avg payment / svc
$703
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
$1,462 9 groups · avg submitted charge / service $22,340
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Data year: CY2024 CY2023 CY2022  CY2021  CY2020 
# Physician group City St Specialty Providers 49659 svcs Submitted charges Avg charge Medicare $ Share of state* Phone
1 SOUTHWEST MEDICAL ASSOCIATES, LLC ALBUQUERQUE NM PHYSICIAN ASSISTANT 328 89 $130,105 $1,462 100.0% (505) 727-7090
2 HEALTHTEXAS PROVIDER NETWORK DALLAS TX PHYSICIAN ASSISTANT 2482 42 $367,401 $8,748 100.0% —
3 UNIVERSITY OF ALABAMA HEALTH SERVICES FOUNDATION, PC BIRMINGHAM AL NURSE PRACTITIONER 2788 32 $332,166 $10,380 100.0% (205) 934-3460
4 ENDEAVOR HEALTH MEDICAL GROUP EVANSTON IL NURSE PRACTITIONER 3380 20 $53,666 $2,683 100.0% —
5 GRAND STRAND SURGICAL SPECIALISTS LLC MYRTLE BEACH SC PHYSICIAN ASSISTANT 51 14 $107,978 $7,713 100.0% (843) 848-1440
That's the top 5 of 9 groups. The platform ranks the whole market — code baskets, benchmarks, and the full ranked list. the full ranking is part of the market analytics platform — built, not launched yet. Notify me at launch →

*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 — and the observed foundation every market figure here builds on. Market totals anchor on a labeled all-Medicare estimate scaled from that foundation, with the observed count disclosed beside it — Medicare only, never all-payer. Modeled all-payer databases project every payer statistically and typically run higher. Same market, different denominator. How the numbers reconcile →