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Market snapshot

99205 nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS

99205 — New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more

Billing groups
7,668
Named-group FFS services
1,720,927
FFS of Medicare
49%
Services YoY
+1.6%
FFS enrollment -2.2%
Estimated all-Medicare volume FFS + estimated MA estimate
~3,461,098 services

1,720,927 observed fee-for-service (50%) · ~1,740,171 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; 2 states without payer-mix data excluded. How we scale

Top states — 99205 (CY2024)

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

Named-group submitted charges
$987.1M
Named-group allowed amount
$353.6M
Named-group Medicare payments
$263.6M
Avg charge / svc
$574
Avg allowed / svc
$205
Avg payment / svc
$153
Average charge per group
$80 7,668 groups · avg submitted charge / service $4,162
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Specialty market — Thoracic Surgery: 1,029 services — specialty benchmark suppressed (fewer than 11 groups) — showing state benchmark. See Thoracic Surgery across all states →

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Data year: CY2024 CY2023 CY2022 🔒 CY2021 🔒 CY2020 🔒
Physician groups ranked by 99205 services, CY2024
#Physician group City St Specialty Providers 99205 svcs Submitted charges Avg charge Medicare $ locked column Share of specialty*Share of state* Phone
1 PHOENIX CARDIAC SURGERY PC PHOENIX AZ THORACIC SURGERY 11 264 $68,640 $260 premium 0.3% (602) 253-9168
2 THE REGENTS OF THE UNIVERSITY OF CALIFORNIA LOS ANGELES CA THORACIC SURGERY 12 221 $300,560 $1,360 premium 0.1% (310) 825-9111
3 CENTRAL COAST CARDIOTHORACIC SURGICAL ASSOCIATES-A MEDICAL GROUP PISMO BEACH CA THORACIC SURGERY 4 175 $39,713 $227 premium 0.0% (805) 556-6001
4 RIVERVIEW CARDIAC SURGERY PA PORT CHARLOTTE FL THORACIC SURGERY 6 161 $69,014 $429 premium 0.1% (941) 744-2640
5 THORACIC FOREGUT SURGERY OF THE UNIVERSITY OF ROCHESTER ROCHESTER NY THORACIC SURGERY 14 77 $33,962 $441 premium 0.0% (585) 275-1509
6 VASCULAR AND CARDIOTHORACIC ASSOCIATES OF MARYLAND PA WESTMINSTER MD THORACIC SURGERY 2 66 $31,672 $480 premium 0.1% (410) 840-8203
7 SOLTERO AND YASUDA ASSOCIATES CARDIOTHORACIC AND VASCULAR SURGERY MEDI NORTHRIDGE CA THORACIC SURGERY 5 49 $26,950 $550 premium 0.0% (818) 993-4471
8 LAKE-PORTER CARDIOVASCULAR PC VALPARAISO IN THORACIC SURGERY 2 16 $4,000 $250 premium 0.0% (219) 462-1619

*"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 →