NEVVI Medicare utilization intelligence
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Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS
J0456 Injection, azithromycin, 500 mg HCPCS · Treatment
Classification Treatment › Injections and Infusions (nononcologic) (CMS RBCS)
First observed 2013 — start of our 12-year window; the code predates it
National scale 242 services · est. · 91 FFS beneficiaries (CY2024, all-Medicare estimate) — 127 observed fee-for-service services
Medicare paid $426 · est. · $1.77 avg / service, national — $224 observed FFS
CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window
Billing groups

2

Named groups billing this code
Named-group all-Medicare svcs · est.

126

Scaled from 63 observed FFS services.
FFS of Medicare

49%

Payer-mix frame
Services · year over year
Services YoY

-7.3%

All-Medicare est. · observed FFS -5.9%
Volume, not care. A shrinking fee-for-service denominator is not a shrinking market.
Estimated all-Medicare volume estimate
FFS + estimated MA

~126 services

63 observed fee-for-service (50%) · ~63 estimated Medicare Advantage.

Billing for this code concentrates in one state — scaled by the national payer mix (FFS share as of 2024) — scaled estimate — assumes MA utilization mirrors FFS; not an observation. How we scale
Top states — J0456 (CY2024)
CA 99 OH 66 MD 46 NC 31

Est. all-Medicare services by billing state (scaled estimate — assumes MA utilization mirrors FFS); open a bar for that state's ranked market.

Billed → allowed → paid
Named-group submitted charges
$5K
Named-group allowed amount
$149
Named-group Medicare payments
$221 · est.
— $110 observed FFS
Avg charge / svc
$84
Avg allowed / svc
$2
Avg payment / svc
$2
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
$50 2 groups · avg submitted charge / service $94
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Data year: CY2024 CY2023 CY2022  CY2021  CY2020 
# Physician group City St Specialty Providers J0456 svcs Submitted charges Avg charge Medicare $ Share of state* Phone
1 SCRIPPS HEALTH LA JOLLA CA PHYSICIAN ASSISTANT 1431 49 $4,596 $94 100.0% (858) 455-9100
2 EASTERN CAROLINA MEDICAL CENTER, PC BENSON NC PHYSICIAN ASSISTANT 5 14 $700 $50 100.0% (919) 894-5787

*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 — and the observed foundation every market figure here builds on. Market totals anchor on a labeled all-Medicare estimate scaled from that foundation, with the observed count disclosed beside it — Medicare only, never all-payer. Modeled all-payer databases project every payer statistically and typically run higher. Same market, different denominator. How the numbers reconcile →