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. In many cases, physicians also influence supply spending by requesting preferred medical devices and supplies. The following list contains the top 25 physician procedures billed to Medicare in 2017 by total volume nationwide — including total payments — based on Definitive Healthcare data.
Routine office visits (CPT codes 99213 & 99214) are the most common and heavily reimbursed of all physician procedures, numbering nearly 195 million with total Medicare payments of over $11.4 billion in 2017, according to Definitive Healthcare. Inpatient care visits (CPT codes 99232 & 99233) followed with a total of 68.8 million cases and nearly $4.4 billion in reimbursements.
Injections also constitute a large number of physician procedures. Of the top 50 billed procedures, injections represent over 30%. Many are drugs related to cancer treatment or chronic kidney disease. Most are relatively inexpensive procedures, with the physician billing only for the act of injecting the medication.
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CPT/HCPCS Code | Description | Total Procedures | Total Payments | Explore These Claims | |
1. | 99214 | OFFICE/OUTPATIENT VISIT EST | 99,626,002 | $6,974,311,013 | Explore This Code |
2. | 99213 | OFFICE/OUTPATIENT VISIT EST | 94,919,508 | $4,471,913,850 | Explore This Code |
3. | Q9967 | LOCM 300-399mg/ml iodine,1ml | 78,668,277 | $7,440,311 | Explore This Code |
4. | 97110 | THERAPEUTIC EXERCISES | 54,393,670 | $1,140,934,353 | Explore This Code |
5. | J1071 | Inj testosterone cypionate | 49,800,446 | $829,013 | Explore This Code |
6. | J1439 | Inj ferric carboxymaltos 1mg | 49,508,115 | $40,598,480 | Explore This Code |
7. | 99232 | SUBSEQUENT HOSPITAL CARE | 46,106,986 | $2,591,914,432 | Explore This Code |
8. | J0897 | Denosumab injection | 37,465,625 | $488,307,369 | Explore This Code |
9. | J0878 | Daptomycin injection | 35,598,810 | $19,604,876 | Explore This Code |
10. | J0881 | Darbepoetin alfa, non-esrd | 31,313,977 | $94,510,055 | Explore This Code |
11. | J0585 | Injection,onabotulinumtoxinA | 30,584,363 | $139,737,460 | Explore This Code |
12. | 97140 | MANUAL THERAPY 1/> REGIONS | 26,088,213 | $475,667,947 | Explore This Code |
13. | Q0138 | Ferumoxytol, non-esrd | 25,846,625 | $17,892,278 | Explore This Code |
14. | 36415 | ROUTINE VENIPUNCTURE | 25,335,944 | $74,048,233 | Explore This Code |
15. | J0717 | Certolizumab Pegol Inj 1mg | 22,635,572 | $131,430,258 | Explore This Code |
16. | 99233 | SUBSEQUENT HOSPITAL CARE | 22,326,900 | $1,830,239,473 | Explore This Code |
17. | Q5101 | Inj filgrastim gcsf biosimil | 20,820,121 | $12,050,132 | Explore This Code |
18. | 93010 | ELECTROCARDIOGRAM REPORT | 18,964,299 | $124,387,384 | Explore This Code |
19. | J1100 | Dexamethasone sodium phos | 18,761,250 | $1,628,913 | Explore This Code |
20. | J3262 | Tocilizumab injection | 18,724,105 | $61,936,152 | Explore This Code |
21. | 17003 | Destruct premalg les 2-14 | 18,065,304 | $71,592,654 | Explore This Code |
22. | J1442 | Inj filgrastim excl biosimil | 17,806,541 | $13,913,848 | Explore This Code |
23. | J1453 | Fosaprepitant injection | 16,141,612 | $24,192,982 | Explore This Code |
24. | 71010 | Chest x-ray 1 view frontal | 15,930,630 | $112,355,963 | Explore This Code |
25. | 88305 | TISSUE EXAM BY PATHOLOGIST | 14,184,470 | $506,548,211 | Explore This Code |
26. | J9267 | Paclitaxel injection | 13,451,978 | $70,876,138 | Explore This Code |
27. | J0885 | Epoetin alfa, non-esrd | 13,162,159 | $374,283,353 | Explore This Code |
28. | 98941 | CHIROPRACT MANJ 3-4 REGIONS | 12,623,458 | $675,838,481 | Explore This Code |
29. | J3301 | Triamcinolone acet inj NOS | 12,600,397 | $124,731,510 | Explore This Code |
30. | J1756 | Iron sucrose injection | 12,298,539 | $19,443,903 | Explore This Code |
31. | 92014 | EYE EXAM&TX ESTAB PT 1/>VST | 11,970,872 | $2,165,013,133 | Explore This Code |
32. | 97530 | THERAPEUTIC ACTIVITIES | 11,900,819 | $705,828,229 | Explore This Code |
33. | 97112 | NEUROMUSCULAR REEDUCATION | 11,871,569 | $704,237,429 | Explore This Code |
34. | A9585 | Gadobutrol injection | 11,862,402 | $33,402,389 | Explore This Code |
35. | 99285 | EMERGENCY DEPT VISIT | 11,470,444 | $12,197,902,558 | Explore This Code |
36. | 99212 | OFFICE/OUTPATIENT VISIT EST | 11,466,146 | $949,753,114 | Explore This Code |
37. | 71020 | Chest x-ray 2vw frontal&latl | 11,385,276 | $617,060,681 | Explore This Code |
38. | 93000 | ELECTROCARDIOGRAM COMPLETE | 11,189,097 | $715,809,261 | Explore This Code |
39. | 85025 | COMPLETE CBC W/AUTO DIFF WBC | 11,133,462 | $354,593,187 | Explore This Code |
40. | J9299 | Injection, nivolumab | 10,802,842 | $653,575,924 | Explore This Code |
41. | 99308 | NURSING FAC CARE SUBSEQ | 10,269,428 | $1,292,414,484 | Explore This Code |
42. | 99223 | INITIAL HOSPITAL CARE | 10,219,906 | $4,630,105,013 | Explore This Code |
43. | 99203 | OFFICE/OUTPATIENT VISIT NEW | 10,193,122 | $2,156,663,225 | Explore This Code |
44. | 95004 | PERCUT ALLERGY SKIN TESTS | 9,506,647 | $115,560,910 | Explore This Code |
45. | 99204 | OFFICE/OUTPATIENT VISIT NEW | 9,190,963 | $2,972,508,881 | Explore This Code |
46. | 99215 | OFFICE/OUTPATIENT VISIT EST | 9,040,347 | $2,567,729,800 | Explore This Code |
47. | A9575 | Inj gadoterate meglumi 0.1ml | 8,732,252 | $12,460,335 | Explore This Code |
48. | 99309 | NURSING FAC CARE SUBSEQ | 8,672,301 | $1,472,795,237 | Explore This Code |
49. | J0641 | Inj., levoleucovorin, 0.5 mg | 8,621,211 | $36,456,919 | Explore This Code |
50. | 96372 | THER/PROPH/DIAG INJ SC/IM | 8,333,190 | $408,238,599 | Explore This Code |
Fig 1. Medicare data is from the Centers for Medicare and Medicaid Services (CMS) Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (PUF). Calendar Year data is projected to be released each July by the CMS. The most recent data is from calendar year 2017; 2018 data is scheduled to be released in July 2020.