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Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS
96161 Administration and interpretation of caregiver-focused health risk assessment CPT · E&M - Miscellaneous
Classification E&M E&M - Miscellaneous (CMS RBCS)
First observed 2017
National scale 6,973 services ▲ 0.4% YoY · 3,214 beneficiaries (CY2024, Medicare FFS)
Medicare paid $13K · $1.89 avg / service, national
CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window
Billing groups
10
Named-group FFS services
2,618
FFS of Medicare
49%
Services YoY
+0.4%
FFS enrollment -2.2%
Estimated all-Medicare volume FFS + estimated MA estimate
~5,208 services

2,618 observed fee-for-service (50%) · ~2,590 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 — 96161 (CY2024)

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

Named-group submitted charges
$16K
Named-group allowed amount
$6K
Named-group Medicare payments
$4K
Avg charge / svc
$6
Avg allowed / svc
$2
Avg payment / svc
$2
Average charge per group
$1 10 groups · avg submitted charge / service $35
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Data year: CY2024 CY2023 CY2022 locked column CY2021 locked column CY2020 locked column
Physician groups ranked by 96161 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 96161 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 HEPHZIBAH VISITING CLINICIANS DESOTO TX NURSE PRACTITIONER 13 936 $3,387 $4 premium 22.6% (469) 941-4029
2 ARTHRITIS CLINIC INC BROOKSVILLE FL RHEUMATOLOGY 2 769 $769 $1 premium 76.6% (352) 596-6333
3 MERCY MEDICAL CENTER CEDAR RAPIDS IA ANESTHESIOLOGY 306 378 $3,402 $9 premium 41.8% (319) 398-6011
4 PRIME MEDICINE LLC GLENN DALE MD INTERNAL MEDICINE 2 352 $6,298 $18 premium 94.9% (301) 805-0006
5 CORPUS FAMILY PRACTICE PLLC CORPUS CHRISTI TX INTERNAL MEDICINE 2 85 $1,190 $14 premium 2.1% (361) 884-3966
6 MEHTA MEDICAL GROUP PLLC HUMBLE TX INTERNAL MEDICINE 25 26 $196 $8 premium 0.6% (281) 446-7173
7 WAKE FOREST UNIVERSITY HEALTH SCIENCES WINSTON SALEM NC PHYSICIAN ASSISTANT 2609 24 $216 $9 premium 100.0% (336) 713-9800
8 MERITUS MEDICAL CENTER INC HAGERSTOWN MD NURSE PRACTITIONER 725 19 $665 $35 premium 5.1%
9 SOUTH LOUISIANA ENT, FACIAL PLASTIC AND HAIR RESTORATION, APMC MANDEVILLE LA OTOLARYNGOLOGY 12 16 $126 $8 premium 100.0% (985) 327-5905
10 BEULAH FAMILY CLINIC PROFESSIONAL LIMITED LIABILITY COMPANY DESOTO TX NURSE PRACTITIONER 3 13 $51 $4 premium 0.3% (682) 405-1934

*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 →