Medicare procedure market data by CPT code & state

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Market snapshot

86695 nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS

86695 — Analysis for antibody to herpes simplex virus, type 1

Billing groups

Named-group FFS services

FFS of Medicare

49%

Services YoY

-5.2%

FFS enrollment -2.2%

Estimated all-Medicare volume FFS + estimated MA estimate

~143 services

64 observed fee-for-service (45%) · ~79 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 — 86695 (CY2024)

NJ 5,013 CA 5,007 FL 2,824 TX 2,479 NC 2,283

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

Named-group submitted charges

$6K

Named-group allowed amount

$817

Named-group Medicare payments

$817

Avg charge / svc

$98

Avg allowed / svc

$13

Avg payment / svc

$13

Average charge per group

$40–63

$63–85

$85–108

$108–131

$131–154

$154–176

$176–199

$199+

$40 4 groups · avg submitted charge / service $250

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 exact payer split, and this market total scaled to all of Medicare, labeled as an estimate.

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 86695 services, CY2024
#	Physician group	City	St	Specialty	Providers	86695 svcs	Submitted charges	Avg charge	Medicare $ locked column	Share*	Phone
1	PHYSICIANS FOR WOMEN'S HEALTH, LLC	DANBURY	CT	OBSTETRICS/GYNECOLOGY	320	23	$920	$40	premium	100.0%	(203) 730-8789
2	CLEVELAND CLINIC	CLEVELAND	OH	PHYSICIAN ASSISTANT	6828	15	$930	$62	premium	3.0%	—
3	PROFESSIONAL GYNECOLOGICAL SERVICES PC	BROOKLYN	NY	OBSTETRICS/GYNECOLOGY	5	15	$3,750	$250	premium	1.0%	(718) 875-4848
4	WOMENS CARE FLORIDA LLC	TAMPA	FL	OBSTETRICS/GYNECOLOGY	334	11	$693	$63	premium	0.4%	(813) 961-7440

*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 →