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Healthcare Insights

Top 25 physician procedures

Physicians are the backbone of any healthcare system. As the primary caregivers, they identify patient ailments and determine courses of treatment that define each episode of care. They also deliver those treatments, sometimes with the assistance of other healthcare professionals.

From an operational perspective, physicians also influence supply spending by requesting preferred medical devices and supplies. A physician’s preferred equipment will largely depend on the types of procedures they’re performing most often.

Using data from the Definitive Healthcare Atlas All-Payor Claims product, we’ve compiled a list of the top 25 physician procedures in 2023 ranked by their percentage of the total procedure volume nationwide. Data represents claims for the year 2023 through September.

Top-billed physician procedures by percentage of total volume in 2023

RankHCPCS/CPT CodeHCPCS/CPT Description% Total ProceduresAvg Charge/ProcedureExplore dataset
199213OFFICE O/P EST LOW 20 MIN4.50%$164 Explore
199214OFFICE O/P EST MOD 30 MIN4.50%$241 Explore
297110THERAPEUTIC EXERCISES2.90%$129 Explore
397530THERAPEUTIC ACTIVITIES2.00%$118 Explore
436415ROUTINE VENIPUNCTURE1.80%$20 Explore
597140MANUAL THERAPY 1/> REGIONS1.60%$88 Explore
785025COMPLETE CBC W/AUTO DIFF WBC1.40%$77 Explore
880053COMPREHEN METABOLIC PANEL1.20%$149 Explore
890837PSYTX W PT 60 MINUTES1.20%$177 Explore
999232SBSQ HOSP IP/OBS MODERATE 351.00%$188 Explore
1099284EMERGENCY DEPT VISIT MOD MDM0.90%$1,254 Explore
113078FDIAST BP <80 MM HG0.80%$0 Explore
113074FSYST BP LT 130 MM HG0.80%$0 Explore
1199204OFFICE O/P NEW MOD 45 MIN0.80%$363 Explore
1299203OFFICE O/P NEW LOW 30 MIN0.70%$240 Explore
1299285EMERGENCY DEPT VISIT HI MDM0.70%$1,725 Explore
133008FBODY MASS INDEX DOCD0.60%$1 Explore
1399233SBSQ HOSP IP/OBS HIGH 500.60%$269 Explore
131159FMED LIST DOCD IN RCRD0.60%$0 Explore
131160FRVW MEDS BY RX/DR IN RCRD0.60%$0 Explore
1471045X-RAY EXAM CHEST 1 VIEW0.50%$165 Explore
14J1644Inj heparin sodium per 1000u0.50%$252 Explore
1499212OFFICE O/P EST SF 10 MIN0.50%$113 Explore
1494040Electrocardiogram Report0.50%$50 Explore

Fig. 1 Data from the Definitive Healthcare’s Atlas All-Payor Claims product for the calendar year 2023 through September. Claims data is sourced from multiple medical claims clearinghouses in the United States and updated monthly. Accessed October 2023.

What are the most common physician procedures in 2023?

The most common procedure in 2023 was a tie between two codes. Routine office visits for established patients (CPT codes 99213 & 99214) each accounted for 4.5% of all procedures so far this year. These codes both refer to a general visit to a physician for an established patient, with the differences between them being the duration of the visit and the level of clinical decision-making. The first-place code refers to visits between 20-29 minutes and involve a minimal amount of care. The second refers to visits that are longer and go between 30-39 minutes. These visits are often for more complex cases and are billed at a higher rate. Most patients typically schedule an appointment with a physician around once a year for a routine checkup and physical examination, so it makes sense that both of these procedures would top the list.

Following routine office visits, the second most common procedure billed by physicians in 2023 is therapeutic exercises (CPT code 97110), accounting for 2.9% of total claims so far. Patients may require physical therapy like this for a wide range of conditions and illnesses. Physical therapy exercises may be needed after surgery, accidents, or other clinical events to prevent loss of motion, maintain or improve muscular strength, or increase flexibility, making it a common procedure.

Rounding out the top three is the code for therapeutic activities (CPT code 97530), accounting for 2% of all physician procedures so far this year. This procedure is similar to therapeutic exercises, but it involves a wider range of dynamic movements designed to replicate real-life movements, such as bending over or walking up stairs, while the former is designed to help the patient make progress in a single parameter, such as strength, flexibility, or endurance. Typically, therapeutic activities build off the work of therapeutic exercises.

What are procedure codes for billing?

Medical procedure codes, or Current Procedural Terminology (CPT) codes, are numerical identifiers and descriptions used to report medical, surgical, and diagnostic services for reimbursement from Medicare and other payors.

Procedure codes give healthcare professionals a standardized language for reporting services, processing claims, and developing new guidelines for medical care review. Codes exist for nearly every point in a patient’s care journey, beginning with their initial contact with a physician’s office. Healthcare administrators must employ correct coding to receive the appropriate reimbursement for services rendered.

What physician procedures have the highest costs?

Despite accounting for fewer procedures, some physician-billed CPT codes have higher costs than those at the top of this list ranked by total volume.

The CPT code on the list of top procedures with the highest average charge per procedure is code 99285, also known as evaluation and management for an emergency department visit involving complex treatment. This code ranks 12th based on the volume of procedures this year but has an average charge of $1,725 per procedure, nearly eight times higher than that of a routine office visit.

In addition to an emergency department visit involving high-complexity treatment, the other most common procedure with the highest average charge is the evaluation and management for an emergency department visit for moderately complex treatments (CPT code 99284) at $1,254 and physician consultations for new patients (CPT 99204) at $363.

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