NEVVI Medicare utilization intelligence
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Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS
J1096 Dexamethasone, lacrimal ophthalmic insert, 0.1 mg HCPCS · Treatment
Classification Treatment › Injections and Infusions (nononcologic) (CMS RBCS)
First observed 2019
National scale 689,080 services · est. ▲ 14.8% YoY · 54,601 FFS beneficiaries (CY2024, all-Medicare estimate) — 356,215 observed fee-for-service services
Medicare paid $64.0M · est. · $92.85 avg / service, national — $33.1M observed FFS
CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window
Billing groups

14

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

23,669

Scaled from 10,935 observed FFS services.
FFS of Medicare

49%

Payer-mix frame
Services · year over year
Services YoY

+14.8%

All-Medicare est. · observed FFS +10.4%
Volume, not care. A shrinking fee-for-service denominator is not a shrinking market.
Estimated all-Medicare volume estimate
FFS + estimated MA

~23,669 services

10,935 observed fee-for-service (46%) · ~12,734 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 — J1096 (CY2024)
AZ 78,245 FL 72,056 NJ 68,350 VA 50,530 TX 42,409

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
$3.9M
Named-group allowed amount
$1.6M
Named-group Medicare payments
$2.7M · est.
— $1.2M observed FFS
Avg charge / svc
$355
Avg allowed / svc
$142
Avg payment / svc
$113
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 14 groups · avg submitted charge / service $1,200
Market analyticsPlatform Methods →

Search a single state to see that market's full analytics — each panel renders gated on the free tier.

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Data year: CY2024 CY2023 CY2022  CY2021  CY2020 
# Physician group City St Specialty Providers J1096 svcs Submitted charges Avg charge Medicare $ Share of state* Phone
1 DR SANDRA M KROKOS AND THOMAS P KISLAN PC HAZLE TOWNSHIP PA OPTOMETRY 11 5,314 $1,077,500 $203 34.7% (570) 453-2020
2 RUSSELL E SWANN M.D. PA WACO TX OPTOMETRY 2 1,172 $1,406,400 $1,200 5.9% —
3 THE EYE DEPOT, P.A. BRADENTON FL OPHTHALMOLOGY 3 1,104 $162,375 $147 3.5% 9417089000118
4 EYE SURGEONS OF CENTRAL NEW YORK, P.C. LIVERPOOL NY OPHTHALMOLOGY 4 784 $644,000 $821 3.9% (315) 362-3937
5 DELRAY EYE ASSOCIATES PA DELRAY BEACH FL OPHTHALMOLOGY 9 636 $186,984 $294 2.0% (561) 498-8100
That's the top 5 of 14 groups. The platform ranks the whole market — code baskets, benchmarks, and the full ranked list. the full ranking is part of the market analytics platform — built, not launched yet. Notify me at launch →

*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 →