NEVVI Medicare utilization intelligence
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Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS
31233 Exam of nasal passage and sinus using an endoscope CPT · Other Organ Systems procedure
Classification Procedure › Other Organ Systems › Nasal/Sinus Endoscopy (CMS RBCS)
First observed 2013 — start of our 12-year window; the code predates it
National scale 3,368 services ▲ 0.2% YoY · 1,590 beneficiaries (CY2024, Medicare FFS)
Medicare paid $888K · $263.52 avg / service, national
CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window
Billing groups

15

Named groups billing this code
Named-group FFS services

721

Attributable volume · fee-for-service
FFS of Medicare

49%

Payer-mix frame
Services · year over year
Services YoY

+0.2%

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

~1,655 services

721 observed fee-for-service (44%) · ~934 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 — 31233 (CY2024)
CA 1,411 PA 545 FL 334 PR 303 NY 251

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
$549K
Named-group allowed amount
$225K
Named-group Medicare payments
$173K
Avg charge / svc
$761
Avg allowed / svc
$312
Avg payment / svc
$240
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
$153 15 groups · avg submitted charge / service $1,143
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Data year: CY2024 CY2023 CY2022  CY2021  CY2020 
# Physician group City St Specialty Providers 31233 svcs Submitted charges Avg charge Medicare $ Share* Phone
1 CLARK HUANG MD PC NEW YORK NY QUALIFIED AUDIOLOGIST 3 134 $125,650 $938 53.4% (212) 308-7333
2 CV ENT SURGICAL GROUP WEST HILLS CA OTOLARYNGOLOGY 3 122 $80,126 $657 8.6% (818) 888-7878
3 EAR NOSE AND THROAT CONSULTANTS OF NORTH MISSISSIPPI PLLC OXFORD MS QUALIFIED AUDIOLOGIST 10 119 $121,376 $1,020 100.0% (662) 234-1337
4 SOUTHWEST MEDICAL ASSOCIATES, LLC ALBUQUERQUE NM PHYSICIAN ASSISTANT 328 79 $43,800 $554 100.0% (505) 727-7090
5 CORPUS CHRISTI ENT SINUS AND ALLERGY,PLLC CORPUS CHRISTI TX NURSE PRACTITIONER 5 55 $47,279 $860 76.4% (361) 287-0100
6 PHYSIOTHERAPY REHABILITATION SERVICES INC BAYAMON PR INTERNAL MEDICINE 49 39 $10,634 $273 12.9% (787) 787-8669
7 EVMS ACADEMIC PHYSICIANS AND SURGEONS HEALTH SERVICES FOUNDATION NORFOLK VA OBSTETRICS/GYNECOLOGY 224 29 $13,950 $481 100.0% (757) 446-7900
8 BERNARD J DURANTE MD PC PLYMOUTH MA PHYSICIAN ASSISTANT 16 28 $32,000 $1,143 50.9% (508) 746-8977
9 TRAUMA AND EMERGENCY SUBSPECIALTY SURGEONS PLLC LONE TREE CO UROLOGY 27 23 $17,250 $750 100.0% (720) 225-1000
10 MELISSA SCHWARTZ, D.O. LLC ELKINS PARK PA OTOLARYNGOLOGY 2 21 $22,591 $1,076 3.9% (215) 887-7380
11 CLEMENT CHOW MD PA SUGAR LAND TX OTOLARYNGOLOGY 2 17 $2,600 $153 23.6% (281) 242-2719
12 THE CHARLOTTE HUNGERFORD HOSPITAL TORRINGTON CT PHYSICIAN ASSISTANT 206 16 $4,994 $312 100.0% (860) 489-0418
13 NEW YORK ALLERGY AND ASTHMA PLLC NEW YORK NY ALLERGY/IMMUNOLOGY 3 15 $15,000 $1,000 6.0% (212) 517-3300
14 IVINSON MEMORIAL HOSPITAL LARAMIE WY NURSE PRACTITIONER 61 13 $7,464 $574 100.0% (307) 742-2142
15 RECINTO DE CIENCIAS MEDICAS RIO PIEDRAS PR ORTHOPEDIC SURGERY 245 11 $4,300 $391 3.6% (787) 777-3535

*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 →