NEVVI Medicare utilization intelligence
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Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS
68720 Creation of drainage tract from tear sac to nasal cavity CPT · Eye procedure
Classification Procedure › Eye (CMS RBCS)
First observed 2013 — start of our 12-year window; the code predates it
National scale 1,115 services ▲ 9.2% YoY · 1,009 beneficiaries (CY2024, Medicare FFS)
Medicare paid $845K · $757.41 avg / service, national
CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window
Billing groups

29

Named groups billing this code
Named-group FFS services

458

Attributable volume · fee-for-service
FFS of Medicare

49%

Payer-mix frame
Services · year over year
Services YoY

+9.2%

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

~914 services

458 observed fee-for-service (50%) · ~456 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 — 68720 (CY2024)
NY 115 CA 102 TX 88 FL 76 SD 60

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
$990K
Named-group allowed amount
$348K
Named-group Medicare payments
$274K
Avg charge / svc
$2,161
Avg allowed / svc
$759
Avg payment / svc
$599
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
$818 29 groups · avg submitted charge / service $3,862
Market analyticsPlatform Methods →

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Data year: CY2024 CY2023 CY2022  CY2021  CY2020 
# Physician group City St Specialty Providers 68720 svcs Submitted charges Avg charge Medicare $ Share* Phone
1 SPRINGFIELD CLINIC, LLP SPRINGFIELD IL NURSE PRACTITIONER 686 28 $108,138 $3,862 66.7% (217) 544-6464
2 REGENTS OF THE UNIVERSITY OF CALIFORNIA ORANGE CA OPHTHALMOLOGY 51 26 $96,795 $3,723 25.5% (714) 456-8068
3 OPHTHALMIC CONSULTANTS OF LONG ISLAND ROCKVILLE CENTRE NY OPHTHALMOLOGY 107 26 $65,000 $2,500 22.6% (516) 766-2519
4 FACIAL AND OCULOPLASTIC SURGERY CENTER OF TEXAS PLLC SAN ANTONIO TX OPHTHALMOLOGY 6 21 $61,668 $2,937 23.9% (210) 495-2367
5 RETINA CONSULTANTS OF NEVADA LLP LAS VEGAS NV OPHTHALMOLOGY 14 21 $59,700 $2,843 45.7% (702) 369-0200
6 ALABAMA OPHTHALMOLOGY ASSOCIATES, P.C. BIRMINGHAM AL OPHTHALMOLOGY 7 19 $32,300 $1,700 63.3% (205) 930-0700
7 OPHTHALMIC FACIAL PLASTIC SURGERY SPECIALISTS FORT MYERS FL OPHTHALMOLOGY 2 17 $31,841 $1,873 22.4% (239) 947-4042
8 VISTAR EYE CENTER, INC ROANOKE VA OPHTHALMOLOGY 29 17 $13,906 $818 60.7% (540) 855-5100
9 RONALD W PELTON MD PHD PC COLORADO SPRINGS CO PLASTIC AND RECONSTRUCTIVE SURGERY 2 16 $20,800 $1,300 31.4% (719) 329-0040
10 WILLIAM MACK M D P A TAMPA FL OPHTHALMOLOGY 2 16 $19,168 $1,198 21.1% (813) 875-5437
11 UNIVERSITY OF UTAH ADULT SERVICES SALT LAKE CITY CO PHYSICIAN ASSISTANT 1783 16 $29,101 $1,819 31.4% (801) 581-2121
12 MORGENSTERN CENTER FOR ORBITAL AND FACIAL PLASTIC SURGERY, INC WAYNE PA PHYSICIAN ASSISTANT 4 15 $36,956 $2,464 46.9% (610) 687-8771
13 OPHTHALMIC PLASTIC SURGERY INC CARMEL IN OPHTHALMOLOGY 6 15 $13,437 $896 45.5% (317) 817-1976
14 BLACK HILLS REGIONAL EYE INSTITUTE LLP RAPID CITY SD OPHTHALMOLOGY 14 15 $34,617 $2,308 25.0% (605) 341-2000
15 CAROLINA EYE ASSOCIATES INC SOUTHERN PINES NC OPHTHALMOLOGY 37 15 $19,545 $1,303 30.0% (910) 295-2100
16 JENNIFER T SCRUGGS MD PA LITTLE ROCK AR OPHTHALMOLOGY 2 14 $21,350 $1,525 56.0% (501) 221-0123
17 THOMAS EYE GROUP PC ROSWELL GA OPTOMETRY 56 14 $34,022 $2,430 24.6% (770) 475-5515
18 TEXAS HEALTH CARE PLLC FORT WORTH TX NURSE PRACTITIONER 364 13 $23,946 $1,842 14.8% (817) 920-0484
19 OPHTHALMIC PLASTIC AND ORBITAL CONSULTANTS PC BETHESDA MD OPHTHALMOLOGY 2 13 $29,550 $2,273 44.8% (301) 571-0000
20 OPHTHALMIC PLASTIC SURGERY SPECIALISTS PLLC JACKSON MS OPHTHALMOLOGY 2 13 $19,500 $1,500 31.7% (601) 355-9537
21 CATALINA EYE CARE PC TUCSON AZ OPHTHALMOLOGY 5 13 $18,251 $1,404 39.4% (520) 576-5110
22 GAINESVILLE EYE ASSOCIATES LLC GAINESVILLE GA OPHTHALMOLOGY 20 13 $27,134 $2,087 22.8% (770) 532-4444
23 OPHTHALMOLOGY LTD SIOUX FALLS SD OPHTHALMOLOGY 14 13 $11,732 $902 21.7% (605) 336-6294
24 NORTHWEST EYELID AND ORBITAL SPECIALISTS PS SPOKANE WA OPHTHALMOLOGY 2 12 $25,440 $2,120 27.3% (509) 279-2176
25 BAPTIST EYE SURGEONS, PLLC KNOXVILLE TN OPHTHALMOLOGY 12 12 $29,976 $2,498 22.6% (865) 579-3920
26 GRENE VISION GROUP LLC WICHITA KS OPHTHALMOLOGY 9 12 $21,000 $1,750 48.0% (316) 722-8883
27 UNIVERSITY OF ALABAMA OPHTHALMOLOGY SERVICES FOUNDATION BIRMINGHAM AL OPHTHALMOLOGY 24 11 $28,451 $2,586 36.7% (205) 325-8620
28 MIKE S. MCFARLAND MDPA LITTLE ROCK AR OPTOMETRY 14 11 $18,395 $1,672 44.0% (501) 830-2020
29 REGENTS OF THE UNIVERSITY OF CALIFORNIA SAN DIEGO CA DIAGNOSTIC RADIOLOGY 2057 11 $38,233 $3,476 10.8% (800) 926-8273

*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 →