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

31000 Irrigation of nasal sinus CPT · Other Organ Systems procedure

Classification Procedure › Other Organ Systems (CMS RBCS)

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

National scale 450 services ▲ 59.6% YoY · 303 beneficiaries (CY2024, Medicare FFS)

Medicare paid $68K · $151.92 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

Attributable volume · fee-for-service

FFS of Medicare

49%

Payer-mix frame

Services · year over year

Services YoY

+59.6%

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

~142 services

66 observed fee-for-service (46%) · ~76 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 — 31000 (CY2024)

FL 310 NY 47 AL 30 LA 16 AR 13

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

$27K

Named-group allowed amount

$9K

Named-group Medicare payments

$6K

Avg charge / svc

$404

Avg allowed / svc

$135

Avg payment / svc

$96

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

$131–209

$209–287

$287–365

$365–443

$443–521

$521–599

$599–677

$677+

$131 4 groups · avg submitted charge / service $764

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.

View the live example →

Data year: CY2024 CY2023 CY2022 CY2021 CY2020

Physician groups ranked by 31000 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	31000 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	ENT ASSOCIATES OF ALABAMA PA	MONTGOMERY	AL	OTOLARYNGOLOGY	3	30	$3,938	$131	premium	100.0%	—
2	CHOCTAW NATION OF OKLAHOMA	TALIHINA	AR	DIAGNOSTIC RADIOLOGY	269	13	$5,850	$450	premium	100.0%	—
3	CITY MEDICAL OF UPPER EAST SIDE PLLC	NEW YORK	NY	PHYSICIAN ASSISTANT	657	12	$8,500	$708	premium	25.5%	(212) 271-4364
4	ROMAN J. DYKUN, MD	WOODSTOCK	IL	OTOLARYNGOLOGY	6	11	$8,400	$764	premium	100.0%	(815) 338-4600

*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 →