NEVVI Medicare utilization intelligence
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Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS
67971 Reconstruction of up to 2/3 of eyelid with tissue from opposite eyelid CPT · Eye procedure
Classification Procedure › Eye (CMS RBCS)
First observed 2013 — start of our 12-year window; the code predates it
National scale 1,089 services · est. ▼ 17.8% YoY · 451 FFS beneficiaries (CY2024, all-Medicare estimate) — 543 observed fee-for-service services
Medicare paid $717K · est. · $658.51 avg / service, national — $358K observed FFS
CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window
Billing groups

6

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

583

Scaled from 291 observed FFS services.
FFS of Medicare

49%

Payer-mix frame
Services · year over year
Services YoY

-17.7%

All-Medicare est. · observed FFS -20.6%
Volume, not care. A shrinking fee-for-service denominator is not a shrinking market.
Estimated all-Medicare volume estimate
FFS + estimated MA

~583 services

291 observed fee-for-service (50%) · ~292 estimated Medicare Advantage.

Billing for this code concentrates in one state — scaled by the national payer mix (FFS share as of 2024) — scaled estimate — assumes MA utilization mirrors FFS; not an observation. How we scale
Top states — 67971 (CY2024)
SC 492 WA 220 CA 211 FL 66 NY 31

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
$783K
Named-group allowed amount
$252K
Named-group Medicare payments
$401K · est.
— $200K observed FFS
Avg charge / svc
$2,690
Avg allowed / svc
$867
Avg payment / svc
$688
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
$923 6 groups · avg submitted charge / service $4,206
Market analyticsPlatform Methods →

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Data year: CY2024 CY2023 CY2022  CY2021  CY2020 
# Physician group City St Specialty Providers 67971 svcs Submitted charges Avg charge Medicare $ Share of state* Phone
1 JERVEY EYE GROUP PA GREENVILLE SC OPHTHALMOLOGY 20 156 $333,503 $2,138 58.0% (864) 458-7956
2 REGENTS OF THE UNIVERSITY OF CALIFORNIA ORANGE CA OPHTHALMOLOGY 51 62 $260,800 $4,206 59.6% (714) 456-8068
3 SAM NAFICY MD PS INC BELLEVUE WA OPHTHALMOLOGY 2 26 $86,225 $3,316 23.0% (425) 450-0880
4 ERIC A COLE MD PS SILVERDALE WA OPHTHALMOLOGY 3 17 $40,724 $2,396 15.0% (360) 613-2600
5 STONY BROOK OPHTHALMOLOGY, UNIVERSITY FACULTY PRACTICE CORPORATION STONY BROOK NY OPHTHALMOLOGY 16 15 $47,625 $3,175 100.0% (631) 444-4090
That's the top 5 of 6 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 →