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

86738 Analysis for antibody to mycoplasma (bacteria) 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 22,325 services ▼ 10.0% YoY · 11,478 beneficiaries (CY2024, Medicare FFS)

Medicare paid $289K · $12.93 avg / service, national

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

Billing groups

Named-group FFS services

1,351

FFS of Medicare

49%

Services YoY

-10.0%

FFS enrollment -2.2%

Estimated all-Medicare volume FFS + estimated MA estimate

~2,466 services

1,351 observed fee-for-service (55%) · ~1,115 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 — 86738 (CY2024)

TX 4,010 NJ 3,217 CA 3,066 NC 2,519 PR 2,384

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

Named-group submitted charges

$120K

Named-group allowed amount

$17K

Named-group Medicare payments

$17K

Avg charge / svc

$89

Avg allowed / svc

$13

Avg payment / svc

$13

Average charge per group

$17–35

$35–52

$52–70

$70–87

$87–105

$105–122

$122–140

$140+

$17 9 groups · avg submitted charge / service $168

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.

View the live example →

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 86738 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	86738 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	HATTIESBURG CLINIC PA	HATTIESBURG	MS	FAMILY PRACTICE	530	473	$39,259	$83	premium	96.9%	(601) 264-6000
2	FACULTY PHYSICIANS AND SURGEONS OF LLUSM	LOMA LINDA	CA	DIAGNOSTIC RADIOLOGY	1317	386	$27,406	$71	premium	12.6%	—
3	MERCY SPECIALTY CLINIC	CLINTON	IA	NURSE PRACTITIONER	66	179	$25,239	$141	premium	64.4%	(563) 243-2511
4	MERCY SPECIALTY CLINIC	CLINTON	IL	NURSE PRACTITIONER	66	74	$10,434	$141	premium	16.8%	(563) 243-2511
5	ADVANCED INTERNAL MEDICINE GROUP PC	GREENVALE	NY	INTERNAL MEDICINE	5	73	$2,701	$37	premium	11.0%	(516) 352-8100
6	STILLWATER MEDICAL CENTER AUTHORITY	STILLWATER	OK	PHYSICIAN ASSISTANT	166	57	$2,280	$40	premium	60.0%	(405) 372-1480
7	SPARTANBURG MEDICAL CENTER	SPARTANBURG	SC	NURSE PRACTITIONER	1070	54	$9,088	$168	premium	83.1%	(864) 587-3000
8	OTTAWA FAMILY PHYSICIANS, CHARTERED	OTTAWA	KS	FAMILY PRACTICE	11	28	$1,680	$60	premium	12.3%	(785) 242-1620
9	BRIDGEVIEW COMMUNITY MENTAL HEALTH CENTER	CLINTON	IA	NURSE PRACTITIONER	7	15	$2,115	$141	premium	5.4%	(563) 243-5633
10	LONGLEAF PRIMARY CARE LLC	ANNISTON	AL	NURSE PRACTITIONER	3	12	$204	$17	premium	5.9%	(256) 241-5470

*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 →