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

88319 Evaluation of specimen enzymes CPT · Anatomic Pathology test

Classification Test › Anatomic Pathology › Surgical Pathology Examination (CMS RBCS)

First observed 2013 — start of our 12-year window; the code predates it

National scale 7,543 services ▼ 1.4% YoY · 1,857 beneficiaries (CY2024, Medicare FFS)

Medicare paid $191K · $25.35 avg / service, national

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

Billing groups

Named-group FFS services

5,616

FFS of Medicare

49%

Services YoY

-1.4%

FFS enrollment -2.2%

Estimated all-Medicare volume FFS + estimated MA estimate

~11,427 services

5,616 observed fee-for-service (49%) · ~5,811 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 — 88319 (CY2024)

MO 2,834 AR 1,470 MN 1,021 CA 516 TX 414

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

Named-group submitted charges

$665K

Named-group allowed amount

$150K

Named-group Medicare payments

$120K

Avg charge / svc

$118

Avg allowed / svc

$27

Avg payment / svc

$21

Average charge per group

$44–80

$80–116

$116–152

$152–187

$187–223

$223–259

$259–295

$295+

$44 15 groups · avg submitted charge / service $379

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 88319 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	88319 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	WASHINGTON UNIVERSITY	SAINT LOUIS	MO	NURSE PRACTITIONER	3070	2,028	$182,520	$90	premium	71.6%	(314) 747-3000
2	NEPHROPATHOLOGY ASSOCIATES, PLC	LITTLE ROCK	AR	PATHOLOGY	28	1,470	$65,165	$44	premium	100.0%	(501) 604-2695
3	MAYO CLINIC	ROCHESTER	MN	NURSE PRACTITIONER	4896	607	$92,871	$153	premium	59.5%	(507) 284-2511
4	PHYSICIANS REFERRAL SERVICE	HOUSTON	TX	NURSE PRACTITIONER	2696	268	$81,994	$306	premium	64.7%	(713) 592-5433
5	LSU HEALTH SCIENCES CENTER SHREVEPORT FACULTY GROUP PRACTICE	SHREVEPORT	LA	PHYSICIAN ASSISTANT	589	252	$54,784	$217	premium	100.0%	(318) 675-8700
6	STANFORD HEALTH CARE	STANFORD	CA	DIAGNOSTIC RADIOLOGY	3039	193	$59,830	$310	premium	37.4%	(650) 723-4000
7	JOHNS HOPKINS UNIVERSITY	BALTIMORE	MD	NURSE PRACTITIONER	2900	188	$17,484	$93	premium	100.0%	(410) 502-4340
8	UCLA PATHOLOGY AND LABORATORY MEDICINE GROUP	LOS ANGELES	CA	PATHOLOGY	65	186	$55,228	$297	premium	36.0%	(310) 267-2625
9	UNIVERSITY OF CALIFORNIA SAN FRANCISCO	SAN FRANCISCO	CA	DIAGNOSTIC RADIOLOGY	1842	99	$6,732	$68	premium	19.2%	(415) 476-4029
10	TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK	NEW YORK	NY	NURSE PRACTITIONER	2273	84	$10,920	$130	premium	46.4%	(212) 305-8559
11	DUKE HEALTH INTEGRATED PRACTICE INC	DURHAM	NY	PHYSICIAN ASSISTANT	3051	63	$4,284	$68	premium	34.8%	(919) 684-8111
12	BRIGHAM AND WOMENS PHYSICIANS ORGANIZATION INC	BOSTON	MA	PHYSICIAN ASSISTANT	2942	53	$5,909	$111	premium	51.5%	(617) 732-5500
13	DARTMOUTH-HITCHCOCK CLINIC	LEBANON	NH	PHYSICIAN ASSISTANT	1441	52	$19,688	$379	premium	100.0%	(603) 650-5000
14	UNIVERSITY OF VERMONT MEDICAL CENTER INC	BURLINGTON	VT	PHYSICIAN ASSISTANT	1194	44	$5,082	$116	premium	100.0%	(802) 847-0000
15	MIDWEST DIAGNOSTIC PATHOLOGY, S.C.	PARK RIDGE	MA	PATHOLOGY	45	29	$2,755	$95	premium	28.2%	(847) 723-2210

*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 →