Medicare procedure market data by CPT code & state

Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS

43253 Injection of diagnostic or therapeutic substance or marker in 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 276 services ▼ 0.7% YoY · 239 beneficiaries (CY2024, Medicare FFS)

Medicare paid $60K · $217.91 avg / service, national

CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window

Billing groups

Named-group FFS services

190

FFS of Medicare

49%

Services YoY

-0.7%

FFS enrollment -2.2%

Estimated all-Medicare volume FFS + estimated MA estimate

~373 services

190 observed fee-for-service (51%) · ~183 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 — 43253 (CY2024)

IN 52 MO 42 CO 41 TX 32 FL 31

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

Named-group submitted charges

$170K

Named-group allowed amount

$41K

Named-group Medicare payments

$32K

Avg charge / svc

$893

Avg allowed / svc

$214

Avg payment / svc

$170

Average charge per group

$618–695

$695–772

$772–849

$849–926

$926–1,003

$1,003–1,080

$1,080–1,157

$1,157+

$618 11 groups · avg submitted charge / service $1,283

Market analyticsPlatform

a taste of the twelve-year trend layer

Market position — where this market sits on volume and growth among all state markets, and its rank.
Worth a look — every state market for this search, ranked by a published score: size, growth, fragmentation, below-expected volume.
Lookalike opportunities — groups billing below what peers of the same specialty, size, and state predict, with the expected figure shown.
National benchmarks — where each group's volume sits nationally and within its specialty.
Market structure — how concentrated this market is, and who owns the volume.
Medicare-wide scaling — the payer split, and this market total scaled to all of Medicare, labeled as an estimate.

Or just look at it: nuclear heart imaging (78452) in Arizona is open as a live example — the full paid view, real data.

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Nevvi's market analytics platform — code baskets, market structure and share, the twelve-year trend layer — is built and not launched yet. We're gathering interest in it.

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Data year: CY2024 CY2023 CY2022 CY2021 CY2020

Physician groups ranked by 43253 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	43253 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	PORTERCARE ADVENTIST HEALTH SYSTEM	DENVER	CO	PHYSICIAN ASSISTANT	748	28	$21,941	$784	premium	68.3%	(303) 778-5797
2	BOCACARE INC	BOCA RATON	MA	PHYSICIAN ASSISTANT	199	25	$26,682	$1,067	premium	100.0%	(561) 955-7100
3	IU HEALTH MEDICAL GROUP, LLC	INDIANAPOLIS	IN	NURSE PRACTITIONER	4250	21	$13,062	$622	premium	40.4%	(888) 484-3258
4	JOHNS HOPKINS UNIVERSITY	BALTIMORE	MD	NURSE PRACTITIONER	2900	19	$16,374	$862	premium	100.0%	(410) 502-4340
5	BSA AMARILLO DIAGNOSTIC CLINIC INC	AMARILLO	TX	NURSE PRACTITIONER	31	19	$12,424	$654	premium	59.4%	(806) 358-0200
6	ORLANDO HEALTH MEDICAL GROUP INC	ORLANDO	FL	PHYSICIAN ASSISTANT	2145	17	$13,481	$793	premium	54.8%	(407) 896-1100
7	LEE HEALTH SYSTEM INC	FORT MYERS	FL	NURSE PRACTITIONER	1370	14	$16,576	$1,184	premium	45.2%	(239) 343-9888
8	TEXAS DIGESTIVE DISEASE CONSULTANTS, PLLC	DALLAS	TX	GASTROENTEROLOGY	613	13	$14,430	$1,110	premium	40.6%	—
9	JOHN MUIR PHYSICIAN NETWORK	WALNUT CREEK	CA	FAMILY PRACTICE	489	12	$13,836	$1,153	premium	52.2%	(925) 296-9720
10	SUTTER VALLEY MEDICAL FOUNDATION	SACRAMENTO	CA	DIAGNOSTIC RADIOLOGY	2420	11	$14,113	$1,283	premium	47.8%	(916) 681-8852
11	KANSAS UNIVERSITY PHYSICIANS INC	KANSAS CITY	MO	NURSE PRACTITIONER	1815	11	$6,803	$618	premium	26.2%	(913) 588-1227

*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 →