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Market snapshot

MA CY2024

Medicare Part B FFS · CY2024 · as published by CMS
43262 Incision of pancreatic outlet using a flexible endoscope 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 10,605 services ▼ 0.7% YoY · 10,416 beneficiaries (CY2024, Medicare FFS)
Medicare paid $582K · $54.84 avg / service, national
CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window · National figures — the MA market is below
Market analyticsPlatform Methods →

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The read
What am I looking at, in one breath?
The read Platform

In Massachusetts, 12 groups bill 43262 — 427 fee-for-service services, and volume is down 3.3% year over year.

Unlock the Platform — the full read, every number below, code baskets, and export. Looking is free; the depth is paid. Notify me at launch →

The orienting line is free; the comparative synthesis — growth rank, concentration, and $/service against the national figure — unlocks with Platform.

The snapshot
The honest, real numbers — free, always.
Billing groups

12

Named groups billing this code in MA
Named-group FFS services

427

Attributable volume · fee-for-service
FFS of Medicare

64%

Payer-mix frame
Named-group coverage

49%

Of Massachusetts’s disclosed Part B services (2024). The rest is billed by clinicians whose volume isn’t attributed to any group — they belong to several groups, or none. How attribution works →
Services · year over year
Services YoY

-3.3%

FFS enrollment -1.4%
Volume, not care. A shrinking fee-for-service denominator is not a shrinking market.
Estimated all-Medicare volume estimate
FFS + estimated MA

~661 services

427 observed fee-for-service (65%) · ~234 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
The market
How big, moving which way, worth how much.
Billed → allowed → paid
Named-group submitted charges
$577K
Named-group allowed amount
$27K
Named-group Medicare payments
$22K
Avg charge / svc
$1,351
Avg allowed / svc
$64
Avg payment / svc
$51
Totals are named-group (attributable) sums. Allowed is Medicare’s fee-schedule recognized price — what CMS recognizes, before the 80% Medicare pays.
Per-service vs national + the payments trend unlock with Platform
12-year trend

The full twelve-year services and payments series, per-year values.

The structure
Who's in this market and how it's shaped.
Average charge per group
$840 12 groups · avg submitted charge / service $1,859
Market structure

Who owns the volume, how concentrated it is, and the drawn unattributed segment.

Market position

Where this market sits on volume and growth among all state markets, and its rank.

National benchmarks

Where each group's volume sits nationally and within its specialty.

The opportunity
So where do I act?
Worth a look

Every state market for this search, ranked by a published score: size, growth, fragmentation, below-expected volume. The cross-market compare view sits alongside.

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Data year: CY2024 CY2023 CY2022  CY2021  CY2020 
# Physician group City Specialty Providers 43262 svcs Submitted charges Avg charge Medicare $ Share* Phone
1 HARVARD MEDICAL FACULTY PHYS AT BETH ISRAEL DEACONESS MED CTR INC BOSTON INTERNAL MEDICINE 1689 68 $113,356 $1,667 12.9% (781) 983-9088
2 LAHEY CLINIC INC BURLINGTON NURSE PRACTITIONER 1400 66 $122,722 $1,859 12.5% —
3 BOCACARE INC BOCA RATON PHYSICIAN ASSISTANT 199 46 $66,748 $1,451 8.7% (561) 955-7100
4 SOUTHCOAST PHYSICIANS GROUP INC FALL RIVER NURSE PRACTITIONER 868 44 $51,152 $1,163 8.3% (508) 973-5919
5 BAYSTATE MEDICAL PRACTICES INC SPRINGFIELD PHYSICIAN ASSISTANT 1326 41 $39,491 $963 7.8% —
6 MEDICAL AFFILIATES OF CAPE COD INC HYANNIS NURSE PRACTITIONER 236 39 $37,361 $958 7.4% (508) 771-1800
7 BRIGHAM AND WOMENS PHYSICIANS ORGANIZATION INC BOSTON PHYSICIAN ASSISTANT 2942 28 $42,080 $1,503 5.3% (617) 732-5500
8 ST CLOUD HOSPITAL SAINT CLOUD PHYSICAL THERAPIST IN PRIVATE PRACTICE 218 27 $36,093 $1,337 5.1% (320) 251-2700
9 MARY WASHINGTON HEALTHCARE PROVIDERS LLC FREDERICKSBURG DIAGNOSTIC RADIOLOGY 267 27 $22,950 $850 5.1% (540) 741-5610
10 RIVERBEND MEDICAL GROUP INC SPRINGFIELD PHYSICIAN ASSISTANT 225 15 $13,080 $872 2.8% (413) 733-4101
11 MASS GENERAL BRIGHAM MEDICAL GROUP NORTHERN MASSACHUSETTS INC SALEM NURSE PRACTITIONER 803 15 $22,692 $1,513 2.8% (978) 741-4133
12 STURDY HEALTH INC ATTLEBORO NURSE PRACTITIONER 196 11 $9,240 $840 2.1% (508) 222-3200

*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 →