Medicare procedure market data by CPT code & state

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Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS

85378 Coagulation function measurement, qualitative or semiquantitative CPT · General Laboratory test

Classification Test › General Laboratory › Clinical Chemistry (CMS RBCS)

First observed 2013 — start of our 12-year window; the code predates it

National scale 916 services ▼ 15.7% YoY · 892 beneficiaries (CY2024, Medicare FFS)

Medicare paid $9K · $9.47 avg / service, national

CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window

Billing groups

Named-group FFS services

577

FFS of Medicare

49%

Services YoY

-15.7%

FFS enrollment -2.2%

Estimated all-Medicare volume FFS + estimated MA estimate

~1,057 services

577 observed fee-for-service (55%) · ~480 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 — 85378 (CY2024)

SC 431 PA 126 IA 120 FL 85 OR 66

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

Named-group submitted charges

$25K

Named-group allowed amount

$5K

Named-group Medicare payments

$5K

Avg charge / svc

$43

Avg allowed / svc

Avg payment / svc

Average charge per group

$25–28

$28–31

$31–34

$34–36

$36–39

$39–42

$42–45

$45+

$25 4 groups · avg submitted charge / service $49

Market analyticsPlatform

a taste of the twelve-year trend layer

Market position — where this market sits on volume and growth among all state markets, and its rank.
Worth a look — every state market for this search, ranked by a published score: size, growth, fragmentation, below-expected volume.
Lookalike opportunities — groups billing below what peers of the same specialty, size, and state predict, with the expected figure shown.
National benchmarks — where each group's volume sits nationally and within its specialty.
Market structure — how concentrated this market is, and who owns the volume.
Medicare-wide scaling — the payer split, and this market total scaled to all of Medicare, labeled as an estimate.

Or just look at it: nuclear heart imaging (78452) in Arizona is open as a live example — the full paid view, real data.

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Nevvi's market analytics platform — code baskets, market structure and share, the twelve-year trend layer — is built and not launched yet. We're gathering interest in it.

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Data year: CY2024 CY2023 CY2022 CY2021 CY2020

Physician groups ranked by 85378 services, highest first, CY2024
#	Physician group activate to sort	City activate to sort	St activate to sort	Specialty activate to sort	Providers activate to sort	85378 svcs sorted descending — activate to reverse	Submitted charges activate to sort	Avg charge activate to sort	Medicare $ locked column	Share* activate to sort	Phone
1	LEXINGTON HEALTH INC	WEST COLUMBIA	SC	NURSE PRACTITIONER	909	376	$18,456	$49	premium	87.2%	(803) 744-4900
2	THE IOWA CLINIC PC	WEST DES MOINES	IA	PHYSICIAN ASSISTANT	302	120	$3,323	$28	premium	100.0%	(515) 343-1000
3	SALEM CLINIC PC	SALEM	OR	DIAGNOSTIC RADIOLOGY	102	66	$2,640	$40	premium	100.0%	(503) 399-2424
4	OWENSBORO MEDICAL PRACTICE, PLLC	OWENSBORO	KY	NURSE PRACTITIONER	19	15	$375	$25	premium	55.6%	(270) 683-8672

*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 →