NEVVI Medicare utilization intelligence
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Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS
31235 Exam of nasal passage and sphenoid 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 266 services ▲ 22.6% YoY · 154 beneficiaries (CY2024, Medicare FFS)
Medicare paid $75K · $281.98 avg / service, national
CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window
Billing groups

4

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

537

Scaled from 266 observed FFS services.
FFS of Medicare

49%

Payer-mix frame
Services · year over year
Services YoY

+26.7%

All-Medicare est. · observed FFS +22.6%
Volume, not care. A shrinking fee-for-service denominator is not a shrinking market.
Estimated all-Medicare volume estimate
FFS + estimated MA

~537 services

266 observed fee-for-service (50%) · ~271 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 — 31235 (CY2024)
CA 163 TX 78 MA 25

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
$464K
Named-group allowed amount
$97K
Named-group Medicare payments
$75K
Avg charge / svc
$1,744
Avg allowed / svc
$364
Avg payment / svc
$282
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
$1,002 4 groups · avg submitted charge / service $2,047
Market analyticsPlatform Methods →

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Data year: CY2024 CY2023 CY2022  CY2021  CY2020 
# Physician group City St Specialty Providers 31235 svcs Submitted charges Avg charge Medicare $ Share of state* Phone
1 UNIVERSITY HEAD AND NECK SURGEONS ORANGE CA OTOLARYNGOLOGY 27 163 $333,692 $2,047 100.0% (714) 456-5731
2 CORPUS CHRISTI ENT SINUS AND ALLERGY,PLLC CORPUS CHRISTI TX NURSE PRACTITIONER 5 54 $54,107 $1,002 69.2% (361) 287-0100
3 DAVID KIEFF MD LLC WELLESLEY MA OTOLARYNGOLOGY 2 25 $34,000 $1,360 100.0% (617) 997-2900
4 ETMC PHYSICIAN GROUP, INC. TYLER TX NURSE PRACTITIONER 373 24 $42,096 $1,754 30.8% (903) 590-5611

*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 →