NEVVI Medicare utilization intelligence
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Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS
86255 Screening test for antibody to noninfectious agent CPT · General Laboratory test
Classification Test General Laboratory Immunoassay (CMS RBCS)
First observed 2013 — start of our 12-year window; the code predates it
National scale 102,189 services ▲ 0.3% YoY · 67,682 beneficiaries (CY2024, Medicare FFS)
Medicare paid $1.2M · $11.95 avg / service, national
CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window
Billing groups
33
Named-group FFS services
11,068
FFS of Medicare
49%
Services YoY
+0.3%
FFS enrollment -2.2%
Estimated all-Medicare volume FFS + estimated MA estimate
~21,766 services

11,068 observed fee-for-service (51%) · ~10,698 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 — 86255 (CY2024)

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

Named-group submitted charges
$816K
Named-group allowed amount
$174K
Named-group Medicare payments
$142K
Avg charge / svc
$74
Avg allowed / svc
$16
Avg payment / svc
$13
Average charge per group
$14 33 groups · avg submitted charge / service $158
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Data year: CY2024 CY2023 CY2022 locked column CY2021 locked column CY2020 locked column
Physician groups ranked by 86255 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 86255 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 UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT DALLAS DALLAS TX PHYSICIAN ASSISTANT 3200 3,131 $259,873 $83 premium 23.9% (214) 633-5555
2 METRO SOUTH PATHOLOGY, INC. SOUTH WEYMOUTH MA PATHOLOGY 5 931 $40,964 $44 premium 20.4% (781) 340-8397
3 ARTHRITIS AND RHEUMATISM ASSOCIATES PC ROCKVILLE MD RHEUMATOLOGY 56 771 $64,764 $84 premium 26.0% (301) 942-7600
4 RHEUMATOLOGY ASSOCIATES AND SUBSIDIARY DALLAS TX RHEUMATOLOGY 23 766 $27,691 $36 premium 5.8% (214) 540-0700
5 RHEUMATOLOGY CONSULTANTS, LLP HEWLETT NY RHEUMATOLOGY 10 615 $21,525 $35 premium 8.4% (516) 295-4481
6 WILMINGTON PATHOLOGY ASSOCIATES PA WILMINGTON NC PATHOLOGY 9 564 $41,736 $74 premium 10.9% (910) 362-9511
7 ALLEGHENY CLINIC PITTSBURGH PA PHYSICIAN ASSISTANT 2293 457 $23,168 $51 premium 25.6%
8 REGENTS OF THE UNIVERSITY OF MICHIGAN ANN ARBOR MI INTERNAL MEDICINE 3330 436 $54,293 $125 premium 63.3% (734) 763-5459
9 STATE UNIVERSITY OF IOWA IOWA CITY IA PHYSICIAN ASSISTANT 1902 420 $43,650 $104 premium 36.5% (319) 678-8201
10 ARTHRITIS AND RHEUMATOLOGY CENTER PC ROSWELL GA RHEUMATOLOGY 22 389 $61,462 $158 premium 7.7% (770) 284-3150
11 MASSACHUSETTS GENERAL PHYSICIANS ORGANIZATION INC BOSTON MA DIAGNOSTIC RADIOLOGY 3532 365 $27,145 $74 premium 8.0% (617) 724-0287
12 WEST CENTRAL PATHOLOGY SPECIALISTS SC QUINCY IL PATHOLOGY 4 318 $30,495 $96 premium 11.8% 21722384006209
13 PATHWAYS PROFESSIONAL ASSOCIATION CONCORD NH PATHOLOGY 4 193 $16,791 $87 premium 77.2% (603) 225-2711
14 BOULDER VALLEY PATHOLOGY P C BOULDER CO PATHOLOGY 4 188 $9,212 $49 premium 41.6% (720) 854-7000
15 BAYLOR COLLEGE OF MEDICINE HOUSTON TX PATHOLOGY 51 188 $3,986 $21 premium 1.4% (713) 481-3513
16 PATHWAYS PROFESSIONAL ASSOCIATION CONCORD TX PATHOLOGY 4 181 $15,747 $87 premium 1.4% (603) 225-2711
17 LIVINGSTON PATHOLOGY ASSOCIATES, LLC LIVINGSTON NJ PATHOLOGY 10 167 $11,690 $70 premium 2.1% (973) 322-5763
18 REGIONAL LABORATORY CONSULTANTS PC DES MOINES IA PATHOLOGY 12 159 $11,130 $70 premium 13.8% (515) 241-8861
19 BRUNSWICK DIAGNOSTICS ASSOCIATES LLC NEW BRUNSWICK NJ PATHOLOGY 5 81 $5,589 $69 premium 1.0% (732) 745-8600
20 UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES LITTLE ROCK AR NURSE PRACTITIONER 1241 69 $2,691 $39 premium 100.0% (501) 686-8000
21 ARTHRITIS AND RHEUMATISM ASSOCIATES PC ROCKVILLE DC RHEUMATOLOGY 56 63 $5,292 $84 premium 35.2% (301) 942-7600
22 ARTHRITIS AND RHEUMATISM ASSOCIATES PC ROCKVILLE CA RHEUMATOLOGY 56 58 $4,872 $84 premium 0.5% (301) 942-7600
23 UNIVERSITY AT BUFFALO PATHOLOGISTS INC BUFFALO NY PATHOLOGY 23 57 $1,425 $25 premium 0.8% (716) 859-5600
24 CENTRAL ILLINOIS PATHOLOGY, SC PEORIA IL PATHOLOGY 13 52 $1,976 $38 premium 1.9% (309) 624-9011
25 THE METROHEALTH SYSTEM CLEVELAND OH NURSE PRACTITIONER 1175 52 $5,616 $108 premium 7.1% (216) 778-7800
26 UNIVERSITY OF MIAMI MIAMI FL NURSE PRACTITIONER 2331 52 $2,692 $52 premium 0.3% (305) 689-5437
27 CLEARWATER PATHOLOGY ASSOCIATES CLEARWATER FL PATHOLOGY 9 49 $3,185 $65 premium 0.3% (727) 462-7000
28 K M B S C CLINTON IL PATHOLOGY 3 35 $476 $14 premium 1.3% (217) 935-9571
29 PATHOLOGY CONSULTANTS INC HAMMOND IN PATHOLOGY 21 32 $1,796 $56 premium 10.2% (219) 989-3700
30 CENTRAL ILLINOIS PATHOLOGY, SC PEORIA NC PATHOLOGY 13 28 $1,064 $38 premium 0.5% (309) 624-9011
31 RHEUMATOLOGY CARE OF GEORGIA LLC MARIETTA GA RHEUMATOLOGY 2 26 $4,108 $158 premium 0.5% (470) 357-6226
32 CLEVELAND CLINIC CLEVELAND OH PHYSICIAN ASSISTANT 6828 26 $3,878 $149 premium 3.6%
33 PARDO FORSTOT BACA AND ALBOUKREK PA BOCA RATON FL RHEUMATOLOGY 6 26 $762 $29 premium 0.2% (561) 955-7100
34 ILLINOIS BONE AND JOINT INSTITUTE, LLC BANNOCKBURN IL ORTHOPEDIC SURGERY 595 25 $1,000 $40 premium 0.9%
35 MIDDLETOWN MEDICAL PC MIDDLETOWN NY NURSE PRACTITIONER 172 20 $282 $14 premium 0.3% (845) 342-4774
36 ST JOSEPHS HEALTHCARE INC PATERSON NJ PSYCHIATRY 21 19 $1,159 $61 premium 0.2% (973) 754-4750
37 CENTRAL ILLINOIS PATHOLOGY, SC PEORIA MN PATHOLOGY 13 18 $684 $38 premium 0.3% (309) 624-9011
38 UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES LITTLE ROCK KS NURSE PRACTITIONER 1241 15 $585 $39 premium 0.5% (501) 686-8000
39 AUSTIN REGIONAL CLINIC PA AUSTIN TX FAMILY PRACTICE 389 15 $795 $53 premium 0.1% (512) 346-6611
40 CLEARWATER PATHOLOGY ASSOCIATES CLEARWATER IL PATHOLOGY 9 11 $715 $65 premium 0.4% (727) 462-7000

*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 →