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Market snapshot

99204 nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS

99204 — New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more

Billing groups
22,690
Named-group FFS services
8,036,779
FFS of Medicare
49%
Services YoY
+1.0%
FFS enrollment -2.2%
Estimated all-Medicare volume FFS + estimated MA estimate
~16,222,556 services

8,036,779 observed fee-for-service (50%) · ~8,185,777 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; 5 states without payer-mix data excluded. How we scale

Top states — 99204 (CY2024)

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

Named-group submitted charges
$3.3B
Named-group allowed amount
$1.3B
Named-group Medicare payments
$889.7M
Avg charge / svc
$416
Avg allowed / svc
$158
Avg payment / svc
$111
Average charge per group
$79 22,690 groups · avg submitted charge / service $2,909
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Specialty market — Sleep Medicine: 1,680 services across 11 groups; top group 36%. See Sleep Medicine across all states →

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Data year: CY2024 CY2023 CY2022 🔒 CY2021 🔒 CY2020 🔒
Physician groups ranked by 99204 services, CY2024
#Physician group City St Specialty Providers 99204 svcs Submitted charges Avg charge Medicare $ locked column Share of specialty*Share of state* Phone
1 THE INSOMNIA AND SLEEP INSTITUTE OF ARIZONA LLC SCOTTSDALE AZ SLEEP MEDICINE 10 599 $290,951 $486 premium 0.2% (480) 745-3547
2 JAMES M ANDRY MD PA SAN ANTONIO TX SLEEP MEDICINE 4 214 $103,790 $485 premium 0.0%
3 SIRISH NAKKA MD INC SANTA CRUZ CA SLEEP MEDICINE 5 186 $61,380 $330 premium 0.0% (844) 387-5337
4 DARYA SOTO MD INC NOVATO CA SLEEP MEDICINE 3 158 $63,200 $400 premium 0.0% (415) 878-0225
5 PACIFIC SLEEP DISORDERS CENTER A CALIFORNIA GENERAL PARTNERSHIP STOCKTON CA SLEEP MEDICINE 9 129 $32,161 $249 premium 0.0% (209) 465-5731
6 PENINSULA SLEEP CENTER INC BURLINGAME CA SLEEP MEDICINE 4 118 $69,384 $588 premium 0.0% (650) 779-4079
7 SARAH PATEL MD PC GLENDALE AZ SLEEP MEDICINE 5 114 $41,040 $360 premium 0.0% (602) 206-6262
8 PACIFIC PULMONARY CONSULTANTS LLC LIHUE HI SLEEP MEDICINE 2 97 $36,339 $375 premium 0.3% (808) 245-5383
9 LIVING GEM PROFESSIONAL CORPORATION TUCSON AZ SLEEP MEDICINE 3 35 $5,670 $162 premium 0.0% (520) 849-7222
10 BEACON SLEEP SERVICES PLLC MORRISTOWN TN SLEEP MEDICINE 2 17 $3,631 $214 premium 0.0% (423) 616-0501
11 SLIIIP MEDICAL GROUP P A BYRON NC SLEEP MEDICINE 11 13 $4,077 $314 premium 0.0% (478) 238-3552

*"Share of specialty" is the group's share of disclosed Medicare-FFS services for the primary code among groups with the SAME modal specialty in the state; "share of state" is the same figure against the whole state. Specialty is each group's modal member specialty from CMS's clinician register — a multi-specialty group carries one label. Where fewer than 11 groups share the specialty in the state, the specialty share renders "—" — the specialty benchmark is suppressed (fewer than 11 groups) and the state share alongside is the benchmark. Group figures sum clinicians affiliated with exactly one group. 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 →