NEVVI Medicare utilization intelligence
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Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS
99281 Emergency department visit for problem that may not require health care professional CPT · E&M
Classification E&M Emergency Department Services Emergency Department E&M (CMS RBCS)
First observed 2013 — start of our 12-year window; the code predates it
National scale 1,146 services ▼ 40.8% YoY · 1,091 beneficiaries (CY2024, Medicare FFS)
Medicare paid $9K · $7.60 avg / service, national
CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window
Billing groups
22
Named-group FFS services
561
FFS of Medicare
49%
Services YoY
-40.8%
FFS enrollment -2.2%
Estimated all-Medicare volume FFS + estimated MA estimate
~1,117 services

561 observed fee-for-service (50%) · ~556 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 — 99281 (CY2024)

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

Named-group submitted charges
$64K
Named-group allowed amount
$6K
Named-group Medicare payments
$4K
Avg charge / svc
$115
Avg allowed / svc
$10
Avg payment / svc
$8
Average charge per group
$13 22 groups · avg submitted charge / service $379
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Data year: CY2024 CY2023 CY2022 locked column CY2021 locked column CY2020 locked column
Physician groups ranked by 99281 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 99281 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 MOUNT SINAI SCHOOL OF MEDICINE OCEANSIDE NY PHYSICIAN ASSISTANT 151 128 $13,440 $105 premium 58.2%
2 DUKE HEALTH INTEGRATED PRACTICE INC DURHAM NC PHYSICIAN ASSISTANT 3051 51 $5,508 $108 premium 46.8% (919) 684-8111
3 CONCORD COMPANY OF ARKANSAS PLLC EL DORADO AR EMERGENCY MEDICINE 11 46 $4,002 $87 premium 40.7% (870) 863-2000
4 MAYO CLINIC JACKSONVILLE JACKSONVILLE FL NURSE PRACTITIONER 1587 37 $14,023 $379 premium 44.6% (904) 953-2000
5 JOHNS HOPKINS UNIVERSITY BALTIMORE MD INTERNAL MEDICINE 720 33 $2,247 $68 premium 19.4% (410) 550-0100
6 ELLIS HOSPITAL SCHENECCTADY NY PHYSICIAN ASSISTANT 247 27 $1,755 $65 premium 12.3% (518) 243-4000
7 MAYO CLINIC ROCHESTER MN NURSE PRACTITIONER 4896 24 $4,200 $175 premium 63.2% (507) 284-2511
8 BAPTIST MEDCARE INC ARKADELPHIA AR EMERGENCY MEDICINE 58 20 $1,740 $87 premium 17.7% (501) 202-2300
9 VI GOVERNMENT HOSPITAL AND HEALTH FACILITIES CORP ST THOMAS VI EMERGENCY MEDICINE 36 19 $2,394 $126 premium 100.0% (340) 776-8311
10 WAKE FOREST UNIVERSITY HEALTH SCIENCES WINSTON SALEM NC PHYSICIAN ASSISTANT 2609 18 $1,116 $62 premium 16.5% (336) 713-9800
11 IGEA BRAIN AND SPINE,PA UNION NJ NEUROSURGERY 19 18 $229 $13 premium 100.0% (908) 688-8800
12 NEW YORK QUEENS MEDICINE AND SURGERY, P.C. FLUSHING NY PHYSICIAN ASSISTANT 408 15 $1,185 $79 premium 6.8% (718) 670-2468
13 WESTCHESTER MEDICAL CENTER ADVANCED PHYSICIAN SERVICES PC VALHALLA NY DIAGNOSTIC RADIOLOGY 875 15 $1,335 $89 premium 6.8%
14 HOUSE CALL MEDICAL SERVICES OF NEW YORK, PLLC BRONX NY NURSE PRACTITIONER 163 15 $1,575 $105 premium 6.8% (718) 618-0401
15 WAGONER HOSPITAL AUTHORITY WAGONER KS FAMILY PRACTICE 20 15 $675 $45 premium 51.7% (918) 485-5514
16 NORTH PACIFIC CARDIOLOGY MEDICAL ARCATA CA EMERGENCY MEDICINE 21 12 $2,233 $186 premium 13.3% 70782272203358
17 HARVARD MEDICAL FACULTY PHYS AT BETH ISRAEL DEACONESS MED CTR INC BOSTON MA INTERNAL MEDICINE 1689 12 $852 $71 premium 32.4% (781) 983-9088
18 GRENADA PHYSICIAN SERVICES, LLC GRENADA MS INTERNAL MEDICINE 15 12 $624 $52 premium 32.4% (662) 227-7000
19 NCHMD INC NAPLES FL NEUROLOGY 515 11 $1,770 $161 premium 13.3% (239) 436-5100
20 LSU HEALTH SCIENCES CENTER SHREVEPORT FACULTY GROUP PRACTICE SHREVEPORT LA PHYSICIAN ASSISTANT 589 11 $1,100 $100 premium 20.4% (318) 675-8700
21 LOYOLA UNIVERSITY MEDICAL CENTER MAYWOOD IL NURSE PRACTITIONER 933 11 $1,122 $102 premium 44.0% (708) 216-8372
22 HEART AND VASCULAR CARE, LLC CUMMING FL CARDIOVASCULAR DISEASE (CARDIOLOGY) 45 11 $1,269 $115 premium 13.3% (678) 513-2273

*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 →