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Market snapshot

J0585 in RI CY2024

Medicare Part B FFS · CY2024 · as published by CMS

J0585 — Injection, onabotulinumtoxina, 1 unit

Billing groups
3
Named-group FFS services
60,493
FFS of Medicare
40%
Services YoY
-11.7%
FFS enrollment -3.5%
Estimated all-Medicare volume FFS + estimated MA estimate
~147,872 services

60,493 observed fee-for-service (41%) · ~87,379 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

Named-group submitted charges
$636K
Named-group allowed amount
$341K
Named-group Medicare payments
$269K
Avg charge / svc
$11
Avg allowed / svc
$6
Avg payment / svc
$4
Average charge per group
$10 3 groups · avg submitted charge / service $16
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Specialty market — Physical Medicine And Rehabilitation: 16,100 services — specialty benchmark suppressed (fewer than 11 groups) — showing state benchmark. See Physical Medicine And Rehabilitation across all states →

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Data year: CY2024 CY2023 CY2022 🔒 CY2021 🔒 CY2020 🔒
Physician groups ranked by J0585 services, CY2024
#Physician group City Specialty Providers J0585 svcs Submitted charges Avg charge Medicare $ locked column Share of specialty*Share of state* Phone
1 CORE PHYSICAL THERAPY AND SPORTS MEDICINE PC BRIDGEPORT PHYSICAL MEDICINE AND REHABILITATION 4 16,100 $165,000 $10 premium 18.6% (203) 373-1593

*"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 →