NEVVI Medicare utilization intelligence
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Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS
43200 Diagnostic exam of esophagus using a flexible endoscope through mouth CPT · Procedure
Classification Procedure Digestive/Gastrointestinal Upper GI Endoscopy (CMS RBCS)
First observed 2013 — start of our 12-year window; the code predates it
National scale 471 services ▼ 24.6% YoY · 432 beneficiaries (CY2024, Medicare FFS)
Medicare paid $40K · $85.09 avg / service, national
CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window
Billing groups
11
Named-group FFS services
268
FFS of Medicare
49%
Services YoY
-24.6%
FFS enrollment -2.2%
Estimated all-Medicare volume FFS + estimated MA estimate
~543 services

268 observed fee-for-service (49%) · ~275 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 — 43200 (CY2024)

Disclosed Medicare fee-for-service services by billing state; open a bar for that state's ranked market.

Named-group submitted charges
$222K
Named-group allowed amount
$18K
Named-group Medicare payments
$14K
Avg charge / svc
$828
Avg allowed / svc
$68
Avg payment / svc
$53
Average charge per group
$310 11 groups · avg submitted charge / service $1,621
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Data year: CY2024 CY2023 CY2022 locked column CY2021 locked column CY2020 locked column
Physician groups ranked by 43200 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 43200 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 UNIVERSITY SURGEONS OF ORANGE A MEDICAL GROUP ORANGE CA GENERAL SURGERY 120 47 $19,787 $421 premium 39.2% (714) 634-5549
2 NORTH SHORE-LIJ MEDICAL PC MANHASSET NY PHYSICIAN ASSISTANT 6294 43 $66,435 $1,545 premium 35.0%
3 SUTTER BAY MEDICAL FOUNDATION PALO ALTO CA INTERNAL MEDICINE 3716 30 $48,630 $1,621 premium 25.0% (415) 600-1020
4 EVMS ACADEMIC PHYSICIANS AND SURGEONS HEALTH SERVICES FOUNDATION NORFOLK VA OBSTETRICS/GYNECOLOGY 224 27 $13,635 $505 premium 100.0% (757) 446-7900
5 MASSACHUSETTS GENERAL PHYSICIANS ORGANIZATION INC BOSTON MA DIAGNOSTIC RADIOLOGY 3532 23 $13,252 $576 premium 100.0% (617) 724-0287
6 OSU OTOLARYNGOLOGY HEAD AND NECK SURGERY LLC COLUMBUS OH OTOLARYNGOLOGY 67 20 $6,200 $310 premium 41.7% (614) 366-3687
7 FLORIDA CLINICAL PRACTICE ASSOCIATION INC GAINESVILLE FL NURSE PRACTITIONER 1912 20 $10,164 $508 premium 100.0% (352) 265-8990
8 OPTUM MEDICAL CARE PC MOUNT KISCO NY INTERNAL MEDICINE 1040 16 $25,450 $1,591 premium 13.0% (914) 241-1050
9 UNIVERSITY HOSPITALS MEDICAL GROUP INC CLEVELAND OH NURSE PRACTITIONER 2232 16 $8,336 $521 premium 33.3%
10 HARVARD MEDICAL FACULTY PHYS AT BETH ISRAEL DEACONESS MED CTR INC BOSTON PA INTERNAL MEDICINE 1689 14 $5,936 $424 premium 53.8% (781) 983-9088
11 TRIHEALTH H LLC CINCINNATI OH OBSTETRICS/GYNECOLOGY 853 12 $4,200 $350 premium 25.0% (513) 246-7000

*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 →