NEVVI Medicare utilization intelligence
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Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS
43497 Incision of muscle of lower esophagus using an endoscope CPT · Procedure
Classification Procedure › Digestive/Gastrointestinal › Upper GI Endoscopy (CMS RBCS)
First observed 2022
National scale 380 services ▼ 6.4% YoY · 377 beneficiaries (CY2024, Medicare FFS)
Medicare paid $238K · $625.41 avg / service, national
CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window
Billing groups

19

Named groups billing this code
Named-group FFS services

343

Attributable volume · fee-for-service
FFS of Medicare

49%

Payer-mix frame
Services · year over year
Services YoY

-6.4%

FFS enrollment -2.2%
Volume, not care. A shrinking fee-for-service denominator is not a shrinking market.
Estimated all-Medicare volume estimate
FFS + estimated MA

~657 services

343 observed fee-for-service (52%) · ~314 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 — 43497 (CY2024)
CA 42 PA 38 MD 36 IL 31 IN 28

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

Billed → allowed → paid
Named-group submitted charges
$908K
Named-group allowed amount
$275K
Named-group Medicare payments
$218K
Avg charge / svc
$2,646
Avg allowed / svc
$800
Avg payment / svc
$635
Totals are named-group (attributable) sums. Allowed is Medicare’s fee-schedule recognized price — what CMS recognizes, before the 80% Medicare pays.
Average charge per group
$1,304 19 groups · avg submitted charge / service $6,026
Market analyticsPlatform Methods →

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Data year: CY2024 CY2023 CY2022  CY2021  CY2020 
# Physician group City St Specialty Providers 43497 svcs Submitted charges Avg charge Medicare $ Share* Phone
1 JOHNS HOPKINS UNIVERSITY BALTIMORE MD NURSE PRACTITIONER 2900 36 $91,985 $2,555 100.0% (410) 502-4340
2 IU HEALTH MEDICAL GROUP, LLC INDIANAPOLIS IN NURSE PRACTITIONER 4250 28 $48,524 $1,733 100.0% (888) 484-3258
3 HONORHEALTH AMBULATORY SCOTTSDALE AZ PHYSICIAN ASSISTANT 601 27 $60,551 $2,243 100.0% —
4 JEFFERSON UNIVERSITY PHYSICIANS PHILADELPHIA PA DIAGNOSTIC RADIOLOGY 1570 26 $54,080 $2,080 68.4% —
5 STANFORD HEALTH CARE STANFORD CA DIAGNOSTIC RADIOLOGY 3039 22 $76,693 $3,486 52.4% (650) 723-4000
6 BOCACARE INC BOCA RATON MA PHYSICIAN ASSISTANT 199 22 $71,854 $3,266 100.0% (561) 955-7100
7 ORLANDO HEALTH MEDICAL GROUP INC ORLANDO FL PHYSICIAN ASSISTANT 2145 21 $51,051 $2,431 100.0% (407) 896-1100
8 SUTTER BAY MEDICAL FOUNDATION PALO ALTO CA INTERNAL MEDICINE 3716 20 $56,340 $2,817 47.6% (415) 600-1020
9 ENDEAVOR HEALTH MEDICAL GROUP EVANSTON IL NURSE PRACTITIONER 3380 16 $30,464 $1,904 51.6% —
10 KANSAS UNIVERSITY PHYSICIANS INC KANSAS CITY MO NURSE PRACTITIONER 1815 15 $28,304 $1,887 55.6% (913) 588-1227
11 NORTHWESTERN MEDICAL FACULTY FOUNDATION CHICAGO IL NURSE PRACTITIONER 4339 15 $64,500 $4,300 48.4% —
12 NORTH SHORE MEDICAL GROUP OF THE MOUNT SINAI SCHOOL OF MEDICINE GREENLAWN NY DIAGNOSTIC RADIOLOGY 315 14 $30,779 $2,198 100.0% (631) 628-5000
13 WASHINGTON UNIVERSITY SAINT LOUIS MO NURSE PRACTITIONER 3070 12 $40,081 $3,340 44.4% (314) 747-3000
14 MAYO CLINIC ROCHESTER MN NURSE PRACTITIONER 4896 12 $72,312 $6,026 100.0% (507) 284-2511
15 PRACTICE ASSOCIATES MEDICAL GROUP MORRISTOWN NJ NURSE PRACTITIONER 1404 12 $35,088 $2,924 100.0% (973) 971-5596
16 THE MILTON S HERSHEY MEDICAL CENTER PHYSICIANS GROUP HERSHEY PA PHYSICIAN ASSISTANT 1599 12 $35,040 $2,920 31.6% (717) 531-5638
17 VIRGINIA MASON MEDICAL CENTER SEATTLE WA PHYSICIAN ASSISTANT 879 11 $24,743 $2,249 100.0% (206) 223-6600
18 MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE INC FLORENCE SC NURSE PRACTITIONER 409 11 $14,345 $1,304 50.0% (843) 777-2000
19 GASTROENTEROLOGY ASSOCIATES, PA GREENVILLE SC GASTROENTEROLOGY 58 11 $20,900 $1,900 50.0% (864) 232-7338

*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 →