NEVVI Medicare utilization intelligence
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Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS
Q5104 Injection, infliximab-abda, biosimilar, (renflexis), 10 mg HCPCS · Treatment
Classification Treatment › Injections and Infusions (nononcologic) › Injection - Monoclonal Antibodies (CMS RBCS)
First observed 2018
National scale 317,132 services ▼ 40.1% YoY · 2,215 beneficiaries (CY2024, Medicare FFS)
Medicare paid $7.3M · $23.07 avg / service, national
CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window
Billing groups

43

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

472,097

Scaled from 225,970 observed FFS services.
FFS of Medicare

49%

Payer-mix frame
Services · year over year
Services YoY

-36.9%

All-Medicare est. · observed FFS -40.1%
Volume, not care. A shrinking fee-for-service denominator is not a shrinking market.
Estimated all-Medicare volume estimate
FFS + estimated MA

~472,097 services

225,970 observed fee-for-service (48%) · ~246,127 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 — Q5104 (CY2024)
MN 38,270 SC 25,917 AR 23,652 MI 18,940 UT 18,440

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
$29.5M
Named-group allowed amount
$6.6M
Named-group Medicare payments
$5.2M
Avg charge / svc
$131
Avg allowed / svc
$29
Avg payment / svc
$23
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
$46 43 groups · avg submitted charge / service $275
Market analyticsPlatform Methods →

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Data year: CY2024 CY2023 CY2022  CY2021  CY2020 
# Physician group City St Specialty Providers Q5104 svcs Submitted charges Avg charge Medicare $ Share of state* Phone
1 ARTICULARIS HEALTHCARE GROUP INC SUMMERVILLE SC RHEUMATOLOGY 47 23,477 $2,230,315 $95 90.6% (843) 572-4840
2 TEXAS ARTHRITIS AND RHEUMATOLOGY TYLER TX PHYSICIAN ASSISTANT 5 16,650 $1,998,000 $120 100.0% (903) 561-9255
3 IHC HEALTH SERVICES INC MURRAY UT PHYSICIAN ASSISTANT 3944 14,320 $972,793 $68 77.7% (801) 261-8346
4 PARK NICOLLET CLINIC ST LOUIS PARK MN PHYSICIAN ASSISTANT 1754 12,720 $1,551,840 $122 33.2% (952) 993-3123
5 DEAN HEALTH SYSTEMS INC MADISON WI PHYSICIAN ASSISTANT 1200 11,533 $2,087,473 $181 71.4% (608) 260-2900
That's the top 5 of 43 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. 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 →