NEVVI Medicare utilization intelligence
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Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS
99425 Principal care management services for a single high-risk disease, each additional 30 minutes provided personally by qualified health care professional, per calendar month CPT · E&M
Classification E&M › Care Management/Coordination › Chronic, Principal, and Transitional Care Management (CMS RBCS)
First observed 2022
National scale 11,788 services ▲ 7.1% YoY · 3,788 beneficiaries (CY2024, Medicare FFS)
Medicare paid $544K · $46.11 avg / service, national
CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window
Billing groups

27

Named groups billing this code
Named-group FFS services

6,359

Attributable volume · fee-for-service
FFS of Medicare

49%

Payer-mix frame
Services · year over year
Services YoY

+7.1%

FFS enrollment -2.2%
Volume, not care. A shrinking fee-for-service denominator is not a shrinking market.
Estimated all-Medicare volume estimate
FFS + estimated MA

~11,720 services

6,359 observed fee-for-service (54%) · ~5,361 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 — 99425 (CY2024)
NJ 2,460 DC 2,106 TX 1,916 IL 1,559 NC 1,217

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

Billed → allowed → paid
Named-group submitted charges
$622K
Named-group allowed amount
$378K
Named-group Medicare payments
$300K
Avg charge / svc
$98
Avg allowed / svc
$60
Avg payment / svc
$47
Totals are named-group (attributable) sums. Allowed is Medicare’s fee-schedule recognized price — what CMS recognizes, before the 80% Medicare pays.
Average charge per group
$58 27 groups · avg submitted charge / service $485
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Data year: CY2024 CY2023 CY2022  CY2021  CY2020 
# Physician group City St Specialty Providers 99425 svcs Submitted charges Avg charge Medicare $ Share* Phone
1 RHEUMATIC DISEASE CENTER PHYSICIANS SC DES PLAINES IL RHEUMATOLOGY 4 13 $1,040 $80 0.8% (847) 800-0998
2 BEAUMONT BONE AND JOINT INSTITUTE PA BEAUMONT TX ORTHOPEDIC SURGERY 19 14 $1,428 $102 0.7% (409) 838-0346
3 POST ACUTE SPECIALISTS OF TEXAS PA AUSTIN TX NURSE PRACTITIONER 25 15 $1,725 $115 0.8% (866) 473-0663
4 WILLIAM NOYES MD PC GRAND FORKS ND MEDICAL ONCOLOGY 4 15 $1,770 $118 100.0% (701) 787-5800
5 CENTER FOR ORTHOPEDIC RESEARCH AND EDUCATION LLC SUN CITY AZ PHYSICIAN ASSISTANT 254 17 $2,428 $143 2.9% (866) 974-2673
6 INFINITE MEDICAL PC LAKELAND RI NURSE PRACTITIONER 87 20 $2,300 $115 100.0% (212) 734-6621
7 INFINITE MEDICAL PC LAKELAND FL NURSE PRACTITIONER 87 23 $2,645 $115 6.7% (212) 734-6621
8 BRONX MEDICAL PRACTICE PC BRONX NY NURSE PRACTITIONER 135 23 $2,070 $90 4.8% (718) 299-7295
9 CSH CORP. DALLAS TX NURSE PRACTITIONER 14 24 $4,800 $200 1.3% (972) 798-8001
10 CORA HEALTH SERVICES INC THE VILLAGES FL ORTHOPEDIC SURGERY 1187 28 $3,500 $125 8.1% (352) 693-3378
11 TEXAS SPECIALIST CENTER PLLC LUFKIN TX ORTHOPEDIC SURGERY 9 29 $3,480 $120 1.5% (936) 634-8800
12 HARBOR YOUTH AND FAMILY COUNSELING TUKWILA WA NURSE PRACTITIONER 29 30 $3,300 $110 100.0% 70279035833583
13 FREDERICKSBURG NEPHROLOGY ASSOCIATES INC FREDERICKSBURG VA NEPHROLOGY 11 31 $2,967 $96 100.0% (540) 371-3010
14 UROLOGY SPECIALISTS CHARTERED SIOUX FALLS SD DIAGNOSTIC RADIOLOGY 45 35 $3,850 $110 100.0% (605) 336-0635
15 RAJIV SIDDARAMU MD PLLC SCOTTSDALE AZ NURSE PRACTITIONER 9 41 $4,100 $100 6.9% (602) 753-8120
16 INFINITE MEDICAL PC LAKELAND PA NURSE PRACTITIONER 87 51 $5,865 $115 100.0% (212) 734-6621
17 CAPITAL CARDIOLOGY ASSOCIATES PLLC ALBANY NY NURSE PRACTITIONER 68 62 $6,820 $110 13.0% (518) 292-6000
18 JAMES PETROS MD INC SAN JOSE CA PHYSICAL MEDICINE AND REHABILITATION 20 74 $35,863 $485 16.7% (408) 528-8833
19 DERMATOLOGY HOUSE CALLS LLC ANDERSON SC NURSE PRACTITIONER 2 93 $6,008 $65 100.0% (864) 365-6405
20 WAKEMED SPECIALISTS GROUP LLC RALEIGH NC PHYSICIAN ASSISTANT 860 97 $16,810 $173 8.0% (919) 350-7270
21 CARDIO AND RENAL THERAPEUTICS OF NORTH TEXAS PLLC MCKINNEY TX NURSE PRACTITIONER 34 108 $8,640 $80 5.6% (214) 272-2774
22 COMMUNITY ORTHOPEDIC MEDICAL GROUP MISSION VIEJO CA PHYSICIAN ASSISTANT 16 127 $17,145 $135 28.7% (949) 348-4000
23 GULFSIDE BEHAVIORAL CARE NP INC BRADENTON FL NURSE PRACTITIONER 3 194 $11,310 $58 56.4% 9417561200103
24 INFINITE MEDICAL PC LAKELAND NY NURSE PRACTITIONER 87 230 $26,450 $115 48.3% (212) 734-6621
25 DAVENPORT MEDICAL INC OAK PARK IL INTERNAL MEDICINE 2 357 $28,560 $80 22.9% (773) 543-8964
26 HEARTFUL CARDIOLOGY, PLLC MANSFIELD TX NURSE PRACTITIONER 3 471 $28,282 $60 24.6% (817) 752-5242
27 MOUNTAIN VIEW HEADACHE AND SPINE INSTITUTE PLLC PHOENIX AZ NURSE PRACTITIONER 8 488 $59,640 $122 81.9% (602) 767-0007
28 SUMMIT MEDICAL ARTS ASSOCIATES LLC NORTH BERGEN NJ INTERNAL MEDICINE 2 904 $100,906 $112 36.7% (201) 453-2800
29 FREEDMAN RPM MEDICAL SC SKOKIE IL FAMILY PRACTICE 2 1,189 $118,900 $100 76.3% (847) 443-1170
30 ADVANCED WELLNESS MARLBORO NJ CHIROPRACTIC 16 1,556 $108,920 $70 63.3% (732) 431-2155

*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 →