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Market snapshot

J0717 in CA CY2024

Medicare Part B FFS · CY2024 · as published by CMS

J0717 — Injection, certolizumab pegol, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)

Billing groups
23
Named-group FFS services
2,581,330
FFS of Medicare
49%
Services YoY
+17.6%
FFS enrollment +0.0%
Estimated all-Medicare volume FFS + estimated MA estimate
~5,237,175 services

2,581,330 observed fee-for-service (49%) · ~2,655,845 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
$35.6M
Named-group allowed amount
$11.6M
Named-group Medicare payments
$9.2M
Avg charge / svc
$14
Avg allowed / svc
$4
Avg payment / svc
$4
Average charge per group
$8 23 groups · avg submitted charge / service $22
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Data year: CY2024 CY2023 CY2022 🔒 CY2021 🔒 CY2020 🔒
Physician groups ranked by J0717 services, CY2024
#Physician group City Specialty Providers J0717 svcs Submitted charges Avg charge Medicare $ locked column Share* Phone
1 CENTER FOR RHEUMATOLOGY MEDICAL CORPORATION LOS ANGELES RHEUMATOLOGY 9 436,407 $4,956,801 $11 premium 10.5% (310) 659-7878
2 INLAND RHEUMATOLOGY AND OSTEOPOROSIS MEDICAL GROUP INC UPLAND RHEUMATOLOGY 4 409,400 $4,485,800 $11 premium 9.8% (909) 982-0099
3 EAST BAY RHEUMATOLOGY MEDICAL GROUP, INC. SAN LEANDRO RHEUMATOLOGY 3 297,200 $5,944,000 $20 premium 7.2% (510) 357-1303
4 ARTHRITIS CONSULTANTS OF NORTH COUNTY A PROFESSIONAL CORPORATION OCEANSIDE INTERNAL MEDICINE 3 160,000 $2,235,212 $14 premium 3.8% (760) 724-5800
5 VIVEK MITTAL MD AND MANISHA MITTAL MD INC FRESNO GASTROENTEROLOGY 2 158,400 $2,851,200 $18 premium 3.8% (559) 900-4013
6 THAILA RAMANUJAM M D INC SANTA CRUZ RHEUMATOLOGY 4 142,003 $1,404,016 $10 premium 3.4% (831) 462-8960
7 UNIVERSITY HEALTHCARE ALLIANCE PLEASANTON INTERNAL MEDICINE 332 132,800 $2,523,200 $19 premium 3.2% (925) 462-7060
8 NATALIE MACLEAN MD A PROFESSIONAL CORPORATION ENCINITAS PHYSICIAN ASSISTANT 3 113,600 $965,600 $8 premium 2.7% (760) 753-7374
9 FEATHER RIVER TRIBAL HEALTH INC OROVILLE NURSE PRACTITIONER 29 95,200 $952,000 $10 premium 2.3% (530) 534-5394
10 PACIFIC ARTHRITIS CARE CENTER INC LOS ANGELES RHEUMATOLOGY 3 80,860 $936,806 $12 premium 1.9% (310) 297-9221
11 ROGER KORNU MD PC TUSTIN NURSE PRACTITIONER 3 69,400 $1,110,400 $16 premium 1.7% (714) 406-4461
12 SAMY METYAS M.D. INC COVINA RHEUMATOLOGY 3 58,454 $1,051,201 $18 premium 1.4% (626) 966-1909
13 CITY OF HOPE MEDICAL FOUNDATION DUARTE NURSE PRACTITIONER 942 58,200 $945,459 $16 premium 1.4% (626) 256-4673
14 KHURRAM ABBASS MD INC SAN JOSE PHYSICIAN ASSISTANT 5 50,400 $1,108,800 $22 premium 1.2% (408) 684-4104
15 CABRILLO CENTER FOR RHEUMATIC DISEASE APC SAN DIEGO RHEUMATOLOGY 5 46,800 $468,000 $10 premium 1.1% (619) 334-4869
16 ENG KLASHMAN AND MEHDI A PARTNERSHIP OF PROFESSIONAL CORPORATIONS TORRANCE RHEUMATOLOGY 3 45,601 $396,949 $9 premium 1.1% (310) 373-0340
17 BORIS D RATINER, MD, INC TARZANA RHEUMATOLOGY 6 42,000 $378,000 $9 premium 1.0% (818) 996-4077
18 RHEUMATOLOGY SERVICES MEDICAL GROUP SAN LUIS OBISPO NURSE PRACTITIONER 9 40,800 $489,600 $12 premium 1.0% 6616958385118
19 AMERICAN ARTHRITIS AND RHEUMATOLOGY ASSOCIATES-CA PC FRESNO RHEUMATOLOGY 13 40,400 $608,000 $15 premium 1.0% (559) 732-9900
20 SANSUM CLINIC SANTA BARBARA INTERNAL MEDICINE 322 38,600 $540,400 $14 premium 0.9% (805) 681-7500
21 DIGNITY HEALTH MEDICAL FOUNDATION FOLSOM DIAGNOSTIC RADIOLOGY 1197 37,200 $736,560 $20 premium 0.9% (916) 983-7476
22 R.S. VENUTURUPALLI, M.D. INC BEVERLY HILLS RHEUMATOLOGY 7 22,400 $470,400 $21 premium 0.5% 3106520010120
23 HEALTHNOMIC PARTNERS LLC LAS VEGAS RHEUMATOLOGY 23 5,205 $76,888 $15 premium 0.1% (702) 476-2287

*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 →