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Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS
86258 Detection of gliadin (deamidated) (dgp) antibody CPT · General Laboratory test
Classification Test General Laboratory Immunoassay (CMS RBCS)
First observed 2022
National scale 104,574 services ▲ 9.6% YoY · 56,140 beneficiaries (CY2024, Medicare FFS)
Medicare paid $1.2M · $11.80 avg / service, national
CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window
Billing groups
8
Named-group FFS services
1,204
FFS of Medicare
49%
Services YoY
+9.6%
FFS enrollment -2.2%
Estimated all-Medicare volume FFS + estimated MA estimate
~2,114 services

1,204 observed fee-for-service (57%) · ~910 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 — 86258 (CY2024)

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

Named-group submitted charges
$67K
Named-group allowed amount
$14K
Named-group Medicare payments
$14K
Avg charge / svc
$56
Avg allowed / svc
$12
Avg payment / svc
$12
Average charge per group
$15 8 groups · avg submitted charge / service $350
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Data year: CY2024 CY2023 CY2022 locked column CY2021 locked column CY2020 locked column
Physician groups ranked by 86258 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 86258 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 CAPITAL DIGESTIVE CARE LLC WASHINGTON MD GASTROENTEROLOGY 238 458 $25,323 $55 premium 48.8% (202) 296-3449
2 FACULTY PHYSICIANS AND SURGEONS OF LLUSM LOMA LINDA CA DIAGNOSTIC RADIOLOGY 1317 332 $4,980 $15 premium 3.0%
3 CLEVELAND CLINIC CLEVELAND OH PHYSICIAN ASSISTANT 6828 144 $16,602 $115 premium 3.8%
4 DUPAGE MEDICAL GROUP LTD GLEN ELLYN IL PHYSICIAN ASSISTANT 1323 108 $3,780 $35 premium 9.9% (630) 469-9200
5 THE AUSTIN DIAGNOSTIC CLINIC PLLC AUSTIN TX NEPHROLOGY 86 58 $2,030 $35 premium 0.6% (512) 447-2211
6 ATRIUS HEALTH INC BOSTON MA NURSE PRACTITIONER 1196 42 $1,302 $31 premium 1.8% (617) 421-1000
7 NORTH SHORE HEMATOLOGY ONCOLOGY ASSOCIATES PC SMITHTOWN NY NURSE PRACTITIONER 462 34 $11,900 $350 premium 0.6% (631) 751-3000
8 TANNER MEMORIAL CLINIC LAYTON OH PHYSICIAN ASSISTANT 249 28 $1,120 $40 premium 0.7% (801) 773-4840

*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 →