NEVVI Medicare utilization intelligence
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Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS
43250 Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using a flexible endoscope with electrical cautery 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 2,397 services ▲ 3.5% YoY · 2,268 beneficiaries (CY2024, Medicare FFS)
Medicare paid $759K · $316.77 avg / service, national
CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window
Billing groups
14
Named-group FFS services
538
FFS of Medicare
49%
Services YoY
+3.5%
FFS enrollment -2.2%
Estimated all-Medicare volume FFS + estimated MA estimate
~1,016 services

538 observed fee-for-service (53%) · ~478 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 — 43250 (CY2024)

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

Named-group submitted charges
$868K
Named-group allowed amount
$78K
Named-group Medicare payments
$62K
Avg charge / svc
$1,614
Avg allowed / svc
$145
Avg payment / svc
$115
Average charge per group
$418 14 groups · avg submitted charge / service $4,713
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Data year: CY2024 CY2023 CY2022 locked column CY2021 locked column CY2020 locked column
Physician groups ranked by 43250 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 43250 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 PREMIER MEDICAL GROUP, LLC BLOOMINGTON IL NURSE PRACTITIONER 10 158 $333,560 $2,111 premium 38.3% (309) 663-9424
2 SINAI HOSPITAL OF BALTIMORE, INC BALTIMORE MD PHYSICIAN ASSISTANT 386 84 $90,720 $1,080 premium 63.6%
3 7 HILL GASTROENTEROLOGY P A OCALA FL GASTROENTEROLOGY 5 55 $42,926 $780 premium 8.2% (352) 401-1919
4 PARAMVIR S RAHAL MD INC BAKERSFIELD CA PHYSICIAN ASSISTANT 6 52 $37,440 $720 premium 8.7% (661) 323-1200
5 NEW YORK UNIVERSITY NEW YORK NY DIAGNOSTIC RADIOLOGY 5704 46 $216,798 $4,713 premium 51.1% (212) 263-9700
6 WALTERS SURGICAL ASSOC PA WHITEVILLE NC GENERAL SURGERY 3 24 $10,025 $418 premium 100.0% (910) 642-3214
7 DAYTON GASTROENTEROLOGY, LLC DAYTON OH GASTROENTEROLOGY 75 20 $17,791 $890 premium 15.0% (937) 320-5050
8 ADIRONDACK MEDICAL CENTER SARANAC LAKE NY PHYSICIAN ASSISTANT 83 18 $11,682 $649 premium 20.0% (518) 897-2981
9 PREMIER PHYSICIANS CENTERS INC WESTLAKE OH INTERNAL MEDICINE 46 15 $12,120 $808 premium 11.3% (440) 333-3332
10 CHICAGO SURGICAL CLINIC LTD ARLINGTON HEIGHTS IL GENERAL SURGERY 3 14 $21,560 $1,540 premium 3.4% (847) 215-0530
11 MEDICAL ASSOCIATES OF FREMONT INC FREMONT CA FAMILY PRACTICE 3 14 $12,740 $910 premium 2.3% (510) 794-1990
12 ER PHYSICIAN GROUP AT JACKSON HOSPITAL MARIANNA FL DIAGNOSTIC RADIOLOGY 139 13 $11,297 $869 premium 1.9% (850) 526-2200
13 PALMETTO GASTROENTEROLOGY AND HEPATOLOGY PA AIKEN SC PHYSICIAN ASSISTANT 4 13 $23,400 $1,800 premium 48.1% (803) 226-9786
14 CHRIS DEMETRIOU MD PC GARDEN CITY NY GASTROENTEROLOGY 6 12 $26,400 $2,200 premium 13.3% 5166503355109

*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 →