A single-code market brief: Medicare volume, market structure, state benchmarks, and what it pays, across 2019–2024. Every figure is computed from public Medicare data and positioned against the 3,567 codes billed at scale.
Ten measures, each on its own page with the figure and the table behind it. Every one is positioned against the 3,567 codes billed at 1,000 services or more in 2024.
No organisation, practice or individual is named or ranked. Every table in this brief is printed in it; nothing it rests on is held back. Figures cover Medicare fee-for-service claims; the estimated all-Medicare figures are described on the next page and in the methods.
Two counts appear throughout. The recorded count is what Medicare fee-for-service claims contain, and it is exact. The estimated all-Medicare count adds the Medicare Advantage side of the programme, which does not file the same claims.
The estimate divides the recorded count by the fee-for-service share of Medicare enrolment for that year. It assumes the procedure is used at the same rate on both sides of the programme, which public data cannot test. Where that assumption fails, the estimate is wrong in a known direction.
Shares, ratios and rates are calculated on recorded claims only, never on the estimate. Scaling both sides of a fraction changes nothing and would imply a precision the estimate does not have.
State markets. The comparison universe is 51 state markets — the 50 states and the District of Columbia. The District of Columbia is not a state. It is counted here because it bills Medicare as a separate market and has its own enrolment count, so it can be ranked alongside the states.
Puerto Rico, Guam, the US Virgin Islands, the other territories and military billing addresses sit outside this universe. National totals include them; state tables do not, so state shares sum to slightly less than the national figure.
Growth baselines. Comparisons in this brief start at 2021. The first year in the series is not used as a base, because a partial or truncated first year fabricates growth, and a COVID year is not used as a base either.
| Measure | 2019 | 2021 | 2024 |
|---|---|---|---|
| Recorded services | 51,034 | 874,073 | 2,500,830 |
| Estimated all-Medicare | 84,970 | 1,563,246 | 5,083,654 |
| Medicare payments | $2,062,544 | $35,468,942 | $93,814,831 |
| Beneficiaries | 17,757 | 185,199 | 490,135 |
| Recorded share of the estimate | 60% | 56% | 49% |
2,500,830 services in 2024, the 95th percentile of the 3,567 codes billed at scale.
Volume rose from 874,073 in 2021 to 2,500,830 in 2024, +42.0 percent a year compounded across 3 years.
Against the 3,567 codes billed at 1,000 services or more in 2024, this sits at the 95th percentile by volume.
The high and low since 2021 are 2,500,830 in 2024 and 874,073 in 2021.
| Year | Services | Change |
|---|---|---|
| 2019 | 51,034 | — |
| 2020 | 345,395 | +576.8% |
| 2021 | 874,073 | +153.1% |
| 2022 | 1,438,115 | +64.5% |
| 2023 | 1,913,465 | +33.1% |
| 2024 | 2,500,830 | +30.7% |
Recorded claims cover fee-for-service only. The estimate adds the Medicare Advantage side of the programme.
Recorded volume rose 186 percent since 2021 while the estimated market rose 225 percent.
The share of the market visible in claims moved from 56 percent to 49 percent. That share is the national fee-for-service enrolment share and is the same for every code.
Shares, ratios and rates elsewhere in this report are calculated on recorded claims only, not on the estimate.
| Year | Recorded | Estimated | Recorded share |
|---|---|---|---|
| 2019 | 51,034 | 84,970 | 60% |
| 2020 | 345,395 | 587,938 | 59% |
| 2021 | 874,073 | 1,563,246 | 56% |
| 2022 | 1,438,115 | 2,694,209 | 53% |
| 2023 | 1,913,465 | 3,743,227 | 51% |
| 2024 | 2,500,830 | 5,083,654 | 49% |
Counting against the population eligible for it separates wider use from a change in who is counted.
Recorded volume rose 186 percent since 2021 while the rate per 1,000 beneficiaries rose 215 percent. The difference between them is the change in the fee-for-service population.
Beneficiaries receiving the procedure moved from 185,199 to 490,135.
This rate is the measure that does not move when enrolment shifts between the two parts of Medicare.
| Year | Per 1,000 | Beneficiaries |
|---|---|---|
| 2019 | 1.54 | 17,757 |
| 2020 | 10.71 | 96,902 |
| 2021 | 28.34 | 185,199 |
| 2022 | 48.49 | 290,843 |
| 2023 | 66.85 | 372,393 |
| 2024 | 89.37 | 490,135 |
2,500,830 services for 490,135 beneficiaries in 2024.
The ratio was 4.72 in 2021 and 5.10 in 2024.
That is the 84th percentile among the comparison set.
A ratio above one means some beneficiaries receive the procedure more than once in a year.
| Year | Services | Beneficiaries | Ratio |
|---|---|---|---|
| 2019 | 51,034 | 17,757 | 2.87 |
| 2020 | 345,395 | 96,902 | 3.56 |
| 2021 | 874,073 | 185,199 | 4.72 |
| 2022 | 1,438,115 | 290,843 | 4.94 |
| 2023 | 1,913,465 | 372,393 | 5.14 |
| 2024 | 2,500,830 | 490,135 | 5.10 |
How many distinct organisations bill the code in each state market.
In 2024, 34 of the 51 state markets have at least eleven organisations billing the code — enough that no single biller's volume can be recovered from the market's total.
Counts are per state market. An organisation billing from two states appears in both, so the counts are not summed to a national figure.
This brief counts organisations; it does not name or rank them, and it publishes no organisation's share.
| State market | Organisations |
|---|---|
| CA | 202 |
| TX | 196 |
| FL | 152 |
| NY | 117 |
| NJ | 90 |
| GA | 87 |
| AZ | 63 |
| IL | 63 |
| NC | 56 |
| MD | 54 |
| Markets with eleven or more | 34 |
The 84th percentile for geographic reach among the 3,567 codes billed at scale.
All 51 state markets record volume for this code in 2024.
That reach is wider than 84 percent of codes billed at comparable volume.
The 51 state markets account for 2,500,289 of 2,500,830 recorded services. The remaining 541 are billed from Puerto Rico, Guam, the Virgin Islands or military addresses, which sit outside the comparison universe.
| State | Services | Share |
|---|---|---|
| CA | 514,251 | 20.6% |
| TX | 261,123 | 10.4% |
| FL | 245,145 | 9.8% |
| NY | 199,018 | 8.0% |
| GA | 118,454 | 4.7% |
| CT | 108,958 | 4.4% |
| NJ | 103,618 | 4.1% |
| VA | 99,743 | 4.0% |
| AZ | 89,459 | 3.6% |
| IL | 66,644 | 2.7% |
| TN | 61,568 | 2.5% |
| MD | 58,818 | 2.4% |
| All 51 state markets | 2,500,289 | 100.0% |
Volume answers how much; the rate answers how intensively, sized to each state’s own eligible population.
Measured per 1,000 fee-for-service beneficiaries, CT records the highest rate, 425 services per 1,000. The lowest recorded rate is 0.49, in VT.
The volume ranking and the rate ranking are different lists: CA records the most services while CT records the highest rate.
A state's rate divides its recorded services by that state's own fee-for-service enrolment for the year, so the measure does not move when enrolment shifts, and no blended divisor is used across states. States absent from the file carry no rate, which is not the same as zero.
| State market | Per 1,000 | Services |
|---|---|---|
| CT | 425 | 108,958 |
| CA | 182 | 514,251 |
| GA | 161 | 118,454 |
| TX | 145 | 261,123 |
| AZ | 142 | 89,459 |
| NY | 130 | 199,018 |
| FL | 128 | 245,145 |
| NJ | 120 | 103,618 |
| VA | 114 | 99,743 |
| NV | 112 | 26,764 |
| National | 89 | 2,500,830 |
More concentrated than 53 percent of comparable codes.
The largest state market accounts for 20.6 percent of recorded volume; the top three account for 40.8 percent.
That places the code at the 53rd percentile for concentration among comparable codes.
Concentration at this level is consistent with a market served from many practices across many states.
| Measure | Share |
|---|---|
| Largest state market | 20.6% |
| Top 3 state markets | 40.8% |
| Top 5 state markets | 53.5% |
| All other state markets | 46.5% |
$93,814,831 in 2024, against a 186 percent move in volume.
Payments rose 164 percent while volume rose 186 percent. The gap between those figures is the change in payment per service.
Payment per service fell 8 percent, from $40.58 to $37.51.
At $37.51 per service the code sits at the 42nd percentile of the comparison set.
| Year | Payments | Per service |
|---|---|---|
| 2019 | $2,062,544 | $40.42 |
| 2020 | $14,090,241 | $40.79 |
| 2021 | $35,468,942 | $40.58 |
| 2022 | $56,203,168 | $39.08 |
| 2023 | $72,037,095 | $37.65 |
| 2024 | $93,814,831 | $37.51 |
A charge-to-payment ratio of 3.03 times in 2024.
The charge rose from $96.89 to $113.58 while the Medicare payment moved from $40.79 to $37.51.
The ratio between them went from 2.38 to 3.03 times.
Provider-grain files begin in 2020, so this page covers a shorter window than the volume pages.
| Year | Charge | Paid | Ratio |
|---|---|---|---|
| 2020 | $96.89 | $40.79 | 2.38× |
| 2021 | $103.26 | $40.58 | 2.54× |
| 2022 | $111.70 | $39.08 | 2.86× |
| 2023 | $113.16 | $37.65 | 3.01× |
| 2024 | $113.58 | $37.51 | 3.03× |
Sources. Volume, payment and provider figures come from the CMS Medicare Physician & Other Practitioners public use files, 2019 to 2024. Enrolment shares come from CMS Medicare Monthly Enrollment. Both are published by the Centers for Medicare & Medicaid Services and carry no licence restriction.
What is counted. A service is a claim line, not a patient encounter. A beneficiary who receives the procedure twice in a year counts once in the beneficiary column and twice in the service column.
Fee-for-service only. The claims files cover Medicare fee-for-service. Medicare Advantage plans cover a growing majority of enrolment and do not file these claims. Every figure labelled “recorded” excludes them.
Suppression. CMS withholds any provider row covering fewer than eleven beneficiaries. A state served only by small billers therefore records nothing here, which is not the same as zero. No share is published for a pool of fewer than eleven billers, and no organisation or individual is named or ranked anywhere in this brief.
Billing state. States are assigned from the practice address on the claim. A centrally analysed test bills from the laboratory’s address whatever the patient’s location, so a highly concentrated map locates billers, not demand.
Comparison set. Percentile positions are against the 3,567 codes with at least 1,000 recorded services in 2024. They describe where this code sits among codes billed at comparable scale, not among all HCPCS codes.
Provider years. Provider-grain files begin in 2020, so the charge page covers a shorter window than the volume pages.
Why these chapters. The chapters in this brief are chosen from the data, not fixed. This code routed as DENSE: 34 state markets clear the 11-group floor and 51 comparative states bill volume (the app's 12-state Market-position gate), so structure and state benchmarks both render. A code whose data supports a different set of claims gets a different set of chapters, so no chapter in this brief rests on a figure the data cannot carry.
Not in this brief. No organisation, practice or individual is named. No commercial or list-price figure is used. No projection of future volume is made, and no statement is made about whether the procedure is used appropriately, or about clinical need.
What is delivered. This brief is delivered as a dated PDF. Every table behind every figure is printed in these pages, so the document is complete on its own. It contains no provider or organisation detail.
Every value plotted in this brief.
| Year | Services | Estimated | Payments | Beneficiaries | Per service | Recorded share |
|---|---|---|---|---|---|---|
| 2019 | 51,034 | 84,970 | $2,062,544 | 17,757 | $40.42 | 60% |
| 2020 | 345,395 | 587,938 | $14,090,241 | 96,902 | $40.79 | 59% |
| 2021 | 874,073 | 1,563,246 | $35,468,942 | 185,199 | $40.58 | 56% |
| 2022 | 1,438,115 | 2,694,209 | $56,203,168 | 290,843 | $39.08 | 53% |
| 2023 | 1,913,465 | 3,743,227 | $72,037,095 | 372,393 | $37.65 | 51% |
| 2024 | 2,500,830 | 5,083,654 | $93,814,831 | 490,135 | $37.51 | 49% |
| State market | Services | Share |
|---|---|---|
| CA | 514,251 | 20.6% |
| TX | 261,123 | 10.4% |
| FL | 245,145 | 9.8% |
| NY | 199,018 | 8.0% |
| GA | 118,454 | 4.7% |
| CT | 108,958 | 4.4% |
| NJ | 103,618 | 4.1% |
| VA | 99,743 | 4.0% |
| AZ | 89,459 | 3.6% |
| IL | 66,644 | 2.7% |
| TN | 61,568 | 2.5% |
| MD | 58,818 | 2.4% |
| MI | 47,871 | 1.9% |
| SC | 41,447 | 1.7% |
| MO | 38,385 | 1.5% |
| NC | 34,896 | 1.4% |
| PA | 31,129 | 1.2% |
| IA | 27,817 | 1.1% |
| NV | 26,764 | 1.1% |
| AL | 26,563 | 1.1% |
| LA | 22,603 | 0.9% |
| IN | 20,916 | 0.8% |
| MA | 20,455 | 0.8% |
| OK | 20,024 | 0.8% |
| State market | Services | Share |
|---|---|---|
| WA | 18,747 | 0.7% |
| OH | 18,246 | 0.7% |
| KS | 17,070 | 0.7% |
| UT | 15,777 | 0.6% |
| MS | 15,440 | 0.6% |
| AR | 15,436 | 0.6% |
| CO | 14,531 | 0.6% |
| DE | 14,217 | 0.6% |
| OR | 13,628 | 0.5% |
| KY | 12,293 | 0.5% |
| NE | 9,092 | 0.4% |
| NM | 8,128 | 0.3% |
| HI | 6,942 | 0.3% |
| ID | 6,155 | 0.2% |
| DC | 5,332 | 0.2% |
| NH | 4,250 | 0.2% |
| MN | 3,444 | 0.1% |
| WI | 3,276 | 0.1% |
| SD | 2,344 | 0.1% |
| WV | 2,231 | 0.1% |
| MT | 2,059 | 0.1% |
| AK | 2,007 | 0.1% |
| WY | 1,469 | 0.1% |
| ME | 1,280 | 0.1% |
| RI | 773 | 0.0% |
| ND | 405 | 0.0% |
| VT | 48 | 0.0% |
| All 51 state markets | 2,500,289 | 100.0% |
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