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Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS
96164 Treatment of behavior impacting health in group setting, initial 30 minutes CPT · E&M
Classification E&M Behavioral Health Services (CMS RBCS)
First observed 2020
National scale 7,988 services ▼ 23.2% YoY · 2,027 beneficiaries (CY2024, Medicare FFS)
Medicare paid $55K · $6.92 avg / service, national
CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window
Billing groups
24
Named-group FFS services
7,383
FFS of Medicare
49%
Services YoY
-23.2%
FFS enrollment -2.2%
Estimated all-Medicare volume FFS + estimated MA estimate
~16,099 services

7,383 observed fee-for-service (46%) · ~8,716 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 — 96164 (CY2024)

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

Named-group submitted charges
$971K
Named-group allowed amount
$68K
Named-group Medicare payments
$51K
Avg charge / svc
$131
Avg allowed / svc
$9
Avg payment / svc
$7
Average charge per group
$10 24 groups · avg submitted charge / service $225
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Data year: CY2024 CY2023 CY2022 locked column CY2021 locked column CY2020 locked column
Physician groups ranked by 96164 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 96164 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 MAYO CLINIC JACKSONVILLE JACKSONVILLE FL NURSE PRACTITIONER 1587 1,690 $380,250 $225 premium 100.0% (904) 953-2000
2 MAYO CLINIC ROCHESTER MN NURSE PRACTITIONER 4896 1,563 $232,887 $149 premium 100.0% (507) 284-2511
3 MAYO CLINIC ARIZONA PHOENIX AZ PHYSICIAN ASSISTANT 1635 1,520 $240,160 $158 premium 86.6% (800) 603-0558
4 FORM HEALTH ASSOCIATES PC BAKERSFIELD CA FAMILY PRACTICE 8 477 $5,929 $12 premium 40.9% (617) 505-1520
5 UNIVERSITY OF CALIFORNIA SAN FRANCISCO SAN FRANCISCO CA DIAGNOSTIC RADIOLOGY 1842 315 $17,926 $57 premium 27.0% (415) 476-4029
6 NORTHERN ARIZONA HEALTHCARE CORPORATION FLAGSTAFF AZ PHYSICIAN ASSISTANT 395 235 $5,875 $25 premium 13.4% (928) 773-2249
7 GREAT MIND COUNSELING AND WELLNESS CENTER LLC LAS VEGAS NV NURSE PRACTITIONER 3 229 $2,350 $10 premium 100.0% (702) 208-2194
8 UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION INC MADISON WI PHYSICIAN ASSISTANT 2523 194 $15,908 $82 premium 36.9% (608) 287-2050
9 VIRGINIA MASON MEDICAL CENTER SEATTLE WA PHYSICIAN ASSISTANT 879 179 $9,129 $51 premium 66.5% (206) 223-6600
10 VANDERBILT UNIVERSITY MEDICAL CENTER NASHVILLE TN NURSE PRACTITIONER 3394 120 $17,160 $143 premium 62.2% (615) 322-5000
11 CLEVELAND CLINIC CLEVELAND OH PHYSICIAN ASSISTANT 6828 117 $7,956 $68 premium 100.0%
12 MARY HITCHCOCK MEMORIAL HOSPITAL LEBANON NH NURSE PRACTITIONER 1270 102 $2,169 $21 premium 100.0% (603) 650-5000
13 STATE UNIVERSITY OF IOWA IOWA CITY IA PHYSICIAN ASSISTANT 1902 89 $3,437 $39 premium 100.0% (319) 678-8201
14 UNIVERSITY OF WISCONSIN SYSTEM NON PAYROLL MADISON WI DIAGNOSTIC RADIOLOGY 111 75 $6,150 $82 premium 14.3% (608) 265-8731
15 BEHAVIORAL MEDICINE INSTITUTE PC KNOXVILLE TN CLINICAL PSYCHOLOGIST 21 73 $1,095 $15 premium 37.8% (865) 264-2400
16 MAYO CLINIC HEALTH SYSTEM-SOUTHWEST WISCONSIN REGION INC LA CROSSE CO FAMILY PRACTICE 547 58 $6,148 $106 premium 100.0% (608) 785-0940
17 THE ASSOCIATION OF UNIVERSITY PHYSICIANS SEATTLE WA PHYSICIAN ASSISTANT 3612 49 $1,398 $29 premium 18.2% (206) 364-0500
18 UNIVERSITY OF UTAH BEHAVIORAL HEALTH SERVICES SALT LAKE CITY UT PSYCHIATRY 184 48 $1,390 $29 premium 55.2% (801) 581-2121
19 ALBERT EINSTEIN MEDICAL CENTER ELKINS PARK PA CLINICAL PSYCHOLOGIST 5 46 $1,840 $40 premium 100.0% (215) 663-6000
20 MAYO CLINIC HEALTH SYSTEM-SOUTHWEST WISCONSIN REGION INC LA CROSSE WI FAMILY PRACTICE 547 45 $4,770 $106 premium 8.6% (608) 785-0940
21 UC REGENTS LOS ANGELES CA PSYCHIATRY 142 42 $1,792 $43 premium 3.6% (310) 825-9111
22 SWEDISH HEALTH SERVICES SEATTLE WA PHYSICIAN ASSISTANT 1033 41 $1,107 $27 premium 15.2%
23 LEGACY GOOD SAMARITAN HOSPITAL AND MEDICAL CENTER PORTLAND OR CARDIOVASCULAR DISEASE (CARDIOLOGY) 194 30 $2,460 $82 premium 41.1% (503) 413-7022
24 MASS GENERAL BRIGHAM MEDICAL GROUP SUBURBAN MASSACHUSETTS INC NEWTON CT INTERNAL MEDICINE 535 26 $945 $36 premium 100.0% (617) 243-6000
25 PEACEHEALTH MEDICAL GROUP EUGENE OR NURSE PRACTITIONER 259 20 $580 $29 premium 27.4% (541) 222-8700

*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 →