Medicare procedure market data by CPT code & state

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Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS

27435 Incision of back portion of knee joint capsule CPT · Musculoskeletal procedure

Classification Procedure › Musculoskeletal (CMS RBCS)

First observed 2013 — start of our 12-year window; the code predates it

National scale 919 services ▲ 37.2% YoY · 855 beneficiaries (CY2024, Medicare FFS)

Medicare paid $212K · $230.49 avg / service, national

CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window

Billing groups

Named groups billing this code

Named-group FFS services

316

Attributable volume · fee-for-service

FFS of Medicare

49%

Payer-mix frame

Services · year over year

Services YoY

+37.2%

FFS enrollment -2.2%

Volume, not care. A shrinking fee-for-service denominator is not a shrinking market.

Estimated all-Medicare volume estimate

FFS + estimated MA

~655 services

316 observed fee-for-service (48%) · ~339 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 — 27435 (CY2024)

CA 437 TX 275 FL 152 NY 32 MI 12

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

$718K

Named-group allowed amount

$89K

Named-group Medicare payments

$71K

Avg charge / svc

$2,273

Avg allowed / svc

$283

Avg payment / svc

$225

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

$991–1,863

$1,863–2,734

$2,734–3,605

$3,605–4,477

$4,477–5,348

$5,348–6,220

$6,220–7,091

$7,091+

$991 8 groups · avg submitted charge / service $10,096

Market analyticsPlatform Methods →

Search a single state to see that market's full analytics — the free tier previews every panel, gated.

Or just look at it: nuclear heart imaging (78452) in Arizona is open as a live example — the full paid view, real data.

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Data year: CY2024 CY2023 CY2022 CY2021 CY2020

Physician groups ranked by 27435 services, highest first, CY2024
#	Physician group activate to sort	City activate to sort	St activate to sort	Specialty activate to sort	Providers activate to sort	27435 svcs sorted descending — activate to reverse	Submitted charges activate to sort	Avg charge activate to sort	Medicare $ locked column	Share* activate to sort	Phone
1	RAMIN GANJIANPOUR MD INC	MISSION HILLS	CA	PHYSICIAN ASSISTANT	4	139	$137,768	$991	premium	31.8%	(818) 361-0136
2	TMI SPORTS MEDICINE AND ORTHOPEDIC SURGERY PA	ARLINGTON	TX	PHYSICIAN ASSISTANT	19	60	$96,169	$1,603	premium	21.8%	(817) 419-0303
3	TEXAS JOINT INSTITUTE, PLLC	DALLAS	TX	PHYSICIAN ASSISTANT	39	33	$42,212	$1,279	premium	12.0%	(972) 566-5255
4	GREGORY MONTALBANO MD,PLLC	STATEN ISLAND	NY	ORTHOPEDIC SURGERY	8	32	$323,086	$10,096	premium	100.0%	(718) 477-5479
5	SUMMIT MEMORIAL MEDICAL GROUP LLC	CASPER	TX	PHYSICIAN ASSISTANT	39	15	$19,524	$1,302	premium	5.5%	(307) 358-2122
6	ORTHOLONESTAR PLLC	DALLAS	TX	PHYSICIAN ASSISTANT	407	13	$16,874	$1,298	premium	4.7%	(214) 220-2468
7	RIO ORTHOPEDICS AND SPORTS MEDICINE, PLLC	NORTH RICHLAND HILLS	TX	ORTHOPEDIC SURGERY	3	13	$52,000	$4,000	premium	4.7%	—
8	MEDICAL ASSOCIATES OF ENGLEWOOD PC	ENGLEWOOD	NJ	INTERNAL MEDICINE	550	11	$30,580	$2,780	premium	100.0%	(201) 894-3158

*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 →