Medicare procedure market data by CPT code & state

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Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS

43499 Other procedure on esophagus CPT · Procedure

Classification Procedure › Digestive/Gastrointestinal (CMS RBCS)

First observed 2013 — start of our 12-year window; the code predates it

National scale 575 services ▲ 7.7% YoY · 441 beneficiaries (CY2024, Medicare FFS)

Medicare paid $108K · $187.28 avg / service, national

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

Billing groups

Named-group FFS services

280

FFS of Medicare

49%

Services YoY

+7.7%

FFS enrollment -2.2%

Estimated all-Medicare volume FFS + estimated MA estimate

~586 services

280 observed fee-for-service (48%) · ~306 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 — 43499 (CY2024)

CA 400 FL 51 OH 39 MD 27 PA 19

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

Named-group submitted charges

$514K

Named-group allowed amount

$83K

Named-group Medicare payments

$66K

Avg charge / svc

$1,835

Avg allowed / svc

$296

Avg payment / svc

$235

Average charge per group

$702–1,505

$1,505–2,307

$2,307–3,110

$3,110–3,913

$3,913–4,715

$4,715–5,518

$5,518–6,320

$6,320+

$702 12 groups · avg submitted charge / service $9,304

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.

View the live example →

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 43499 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	43499 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	REGENTS OF THE UNIV OF CA	SACRAMENTO	CA	DIAGNOSTIC RADIOLOGY	1608	101	$86,276	$854	premium	25.2%	(877) 827-7463
2	REGENTS OF THE UNIVERSITY OF CALIFORNIA	SAN DIEGO	CA	DIAGNOSTIC RADIOLOGY	2057	31	$24,453	$789	premium	7.8%	(800) 926-8273
3	OHIOHEALTH CORPORATION	COLUMBUS	OH	PHYSICIAN ASSISTANT	2282	27	$24,157	$895	premium	69.2%	—
4	THE MILTON S HERSHEY MEDICAL CENTER PHYSICIANS GROUP	HERSHEY	PA	PHYSICIAN ASSISTANT	1599	19	$38,815	$2,043	premium	100.0%	(717) 531-5638
5	PROVIDENCE SAINT JOHNS MEDICAL FOUNDATION	SANTA MONICA	CA	PHYSICIAN ASSISTANT	287	16	$11,238	$702	premium	4.0%	(310) 829-6789
6	MAYO CLINIC JACKSONVILLE	JACKSONVILLE	FL	NURSE PRACTITIONER	1587	14	$130,253	$9,304	premium	27.5%	(904) 953-2000
7	LEE HEALTH SYSTEM INC	FORT MYERS	FL	NURSE PRACTITIONER	1370	13	$45,123	$3,471	premium	25.5%	(239) 343-9888
8	PRAMOD JOSEPH MD LLC	FORT PIERCE	FL	GASTROENTEROLOGY	3	13	$18,200	$1,400	premium	25.5%	(772) 567-6181
9	TRIAD HEALTH SERVICES LLC	YOUNGSTOWN	OH	PHYSICIAN ASSISTANT	256	12	$18,000	$1,500	premium	30.8%	(330) 729-8000
10	HONORHEALTH AMBULATORY	SCOTTSDALE	AZ	PHYSICIAN ASSISTANT	601	12	$25,268	$2,106	premium	100.0%	—
11	ORLANDO HEALTH MEDICAL GROUP INC	ORLANDO	FL	PHYSICIAN ASSISTANT	2145	11	$33,167	$3,015	premium	21.6%	(407) 896-1100
12	BRIGHAM AND WOMENS PHYSICIANS ORGANIZATION INC	BOSTON	MA	PHYSICIAN ASSISTANT	2942	11	$58,721	$5,338	premium	100.0%	(617) 732-5500

*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 →