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Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS
43240 Drainage of fluid collection of esophagus, stomach, and/or upper small bowel using a flexible endoscope CPT · Procedure
Classification Procedure Digestive/Gastrointestinal Upper GI Endoscopy (CMS RBCS)
First observed 2014
National scale 120 services ▲ 27.7% YoY · 110 beneficiaries (CY2024, Medicare FFS)
Medicare paid $33K · $272.34 avg / service, national
CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window
Billing groups
6
Named-group FFS services
87
FFS of Medicare
49%
Services YoY
+27.7%
FFS enrollment -2.2%
Estimated all-Medicare volume FFS + estimated MA estimate
~181 services

87 observed fee-for-service (48%) · ~94 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 — 43240 (CY2024)

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

Named-group submitted charges
$146K
Named-group allowed amount
$31K
Named-group Medicare payments
$25K
Avg charge / svc
$1,678
Avg allowed / svc
$356
Avg payment / svc
$282
Average charge per group
$867 6 groups · avg submitted charge / service $2,480
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a taste of the twelve-year trend layer

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Data year: CY2024 CY2023 CY2022 locked column CY2021 locked column CY2020 locked column
Physician groups ranked by 43240 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 43240 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 ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI NEW YORK NY PHYSICIAN ASSISTANT 2818 21 $37,800 $1,800 premium 63.6% (212) 241-4812
2 OSF MULTI-SPECIALTY GROUP PEORIA MO NURSE PRACTITIONER 2091 15 $33,135 $2,209 premium 100.0% (309) 683-5050
3 WILMINGTON GASTROENTEROLOGY ASSOCIATES, PA WILMINGTON NC PHYSICIAN ASSISTANT 21 14 $16,064 $1,147 premium 100.0% (910) 362-1011
4 SCRIPPS HEALTH LA JOLLA CA PHYSICIAN ASSISTANT 1431 13 $18,857 $1,451 premium 100.0% (858) 455-9100
5 TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK NEW YORK NY NURSE PRACTITIONER 2273 12 $29,760 $2,480 premium 36.4% (212) 305-8559
6 BON SECOURS MEDICAL GROUP GREENVILLE SPECIALTY CARE LLC GREENVILLE SC NURSE PRACTITIONER 288 12 $10,404 $867 premium 100.0% (864) 255-1901

*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 →