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

86663 Analysis for antibody to epstein-barr virus (mononucleosis virus), early antigen 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 16,977 services ▼ 0.6% YoY · 14,189 beneficiaries (CY2024, Medicare FFS)

Medicare paid $218K · $12.84 avg / service, national

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

Billing groups

Named groups billing this code

Named-group FFS services

Attributable volume · fee-for-service

FFS of Medicare

49%

Payer-mix frame

Services · year over year

Services YoY

-0.6%

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

~202 services

97 observed fee-for-service (48%) · ~105 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 — 86663 (CY2024)

NJ 4,476 NY 2,978 TX 1,554 NC 1,423 CA 1,227

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

$4K

Named-group allowed amount

$1K

Named-group Medicare payments

$1K

Avg charge / svc

$37

Avg allowed / svc

$13

Avg payment / svc

$13

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

$20–26

$26–33

$33–40

$40–46

$46–52

$52–59

$59–66

$66+

$20 3 groups · avg submitted charge / service $75

Market analyticsPlatform Methods →

Search a single state to see that market's full analytics — the free tier previews every panel, gated.

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

View the live example →

Data year: CY2024 CY2023 CY2022 CY2021 CY2020

Physician groups ranked by 86663 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	86663 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	OGDEN CLINIC PC	OGDEN	UT	PHYSICIAN ASSISTANT	104	48	$960	$20	premium	48.0%	(801) 475-3100
2	RHEUMATOLOGY CONSULTANTS, LLP	HEWLETT	NY	RHEUMATOLOGY	10	35	$1,575	$45	premium	1.2%	(516) 295-4481
3	NORTH SHORE HEMATOLOGY ONCOLOGY ASSOCIATES PC	SMITHTOWN	NY	NURSE PRACTITIONER	462	14	$1,050	$75	premium	0.5%	(631) 751-3000

*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 →