The Most Expensive Medicare Procedures in 2023
Published February 2026 · 10 min read
Key Finding
Office visits (99214) are Medicare's most expensive procedure by total spending at $73.3B over 10 years. But the most expensive procedures per service are drug injections and complex surgeries costing thousands per administration.
Top 20 by Total Medicare Payments
These are the 20 procedure codes that have cost Medicare the most over the past decade (2014-2023). Volume matters: a $73 office visit performed nearly a billion times outspends a $1,800 injection.
| # | Code | Description | Total Payments | Avg/Service | Services |
|---|---|---|---|---|---|
| 1 | 99214 | Established patient office or other outpatient, visit typically 25 minutes | $73.3B | $72.68 | 974.7M |
| 2 | 99213 | Established patient office or other outpatient visit, typically 15 minutes | $44.4B | $49.50 | 870.5M |
| 3 | 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | $24.3B | $56.54 | 425.2M |
| 4 | 💊 J0178 | Injection, aflibercept, 1 mg | $19.7B | $741.31 | 26.8M |
| 5 | 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | $19.2B | $82.48 | 230.1M |
| 6 | 66984 | Removal of cataract with insertion of lens | $16.3B | $349.74 | 74.2M |
| 7 | A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als1-emergency) | $15.8B | $351.69 | 45.6M |
| 8 | 99223 | Initial hospital inpatient care, typically 70 minutes per day | $15.2B | $154.56 | 98.0M |
| 9 | 99285 | Emergency department visit, problem with significant threat to life or function | $14.2B | $133.79 | 103.9M |
| 10 | 99204 | New patient office or other outpatient visit, typically 45 minutes | $10.9B | $111.38 | 96.1M |
| 11 | 97110 | Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | $10.9B | $20.02 | 545.8M |
| 12 | 99215 | Established patient office or other outpatient, visit typically 40 minutes | $10.1B | $104.43 | 93.9M |
| 13 | 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | $9.6B | $176.49 | 54.2M |
| 14 | 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | $9.3B | $79.09 | 111.2M |
| 15 | A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | $8.3B | $296.91 | 27.8M |
| 16 | G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | $8.2B | $114.82 | 70.3M |
| 17 | A0425 | Ground mileage, per statute mile | $8.1B | $6.79 | 1.3B |
| 18 | A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | $8.0B | $177.99 | 47.0M |
| 19 | 💊 J2778 | Injection, ranibizumab, 0.1 mg | $7.8B | $269.98 | 28.4M |
| 20 | 88305 | Pathology examination of tissue using a microscope, intermediate complexity | $7.3B | $33.41 | 188.8M |
Volume vs. Unit Cost: Two Different Stories
The total payments table is dominated by office visits and evaluation codes — services performed hundreds of millions of times. But if you sort by cost per service, the picture changes dramatically. The most expensive individual services are drug injections, chemotherapy administrations, and complex surgical procedures.
Top 20 by Average Cost Per Service
These are the most expensive procedures on a per-service basis (minimum 1,000 providers to exclude rare one-off codes):
| # | Code | Description | Avg/Service | Total Payments | Providers |
|---|---|---|---|---|---|
| 1 | 37227 | Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure | $8.5K | $1.1B | 3.7K |
| 2 | C9740 | Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants | $5.0K | $213.7M | 1.1K |
| 3 | 37229 | Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure | $5.0K | $1.5B | 5.5K |
| 4 | 63685 | Insertion of spinal neurostimulator pulse generator or receiver | $4.7K | $1.3B | 10.2K |
| 5 | 37225 | Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure | $4.5K | $1.3B | 7.7K |
| 6 | 36906 | Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation | $4.1K | $211.5M | 1.8K |
| 7 | A0431 | Ambulance service, conventional air services, transport, one way (rotary wing) | $3.8K | $2.5B | 3.1K |
| 8 | 64590 | Insertion or replacement of peripheral or gastric neurostimulator generator | $3.8K | $336.2M | 3.5K |
| 9 | V2785 | Processing, preserving and transporting corneal tissue | $3.1K | $247.7M | 2.3K |
| 10 | 💊 J2505 | Injection, pegfilgrastim, 6 mg | $3.0K | $2.8B | 16.4K |
| 11 | 36903 | Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation | $2.9K | $282.3M | 2.6K |
| 12 | 37238 | Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation | $2.1K | $245.5M | 3.1K |
| 13 | 36482 | Chemical destruction of incompetent vein of arm or leg, accessed through the skin using imaging guidance | $1.5K | $338.2M | 3.6K |
| 14 | 64561 | Insertion of sacral nerve neurostimulator electrodes, accessed through the skin | $1.4K | $202.3M | 3.0K |
| 15 | 36905 | Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation | $1.4K | $284.7M | 4.8K |
| 16 | 63650 | Implantation of spinal neurostimulator electrodes, accessed through the skin | $1.3K | $1.1B | 12.4K |
| 17 | 33405 | Replacement of left lower heart chamber valve using artificial valve on heart-lung machine | $1.2K | $223.6M | 9.2K |
| 18 | 36465 | Injection of chemical agent into single incompetent vein of leg using ultrasound guidance | $1.2K | $293.8M | 3.5K |
| 19 | 33285 | Insertion of heart rhythm monitor under skin | $1.1K | $270.8M | 7.9K |
| 20 | 65778 | Insertion of amniotic membrane to eye surface | $1.1K | $255.2M | 3.8K |
The Drug Factor
Physician-administered drugs (Part B drugs) account for $85.5B of total Medicare procedure spending (11.2%). These are drugs given in a doctor's office or outpatient setting — not prescriptions you fill at a pharmacy.
The biggest single drug by Medicare spending is aflibercept (Eylea), an eye injection used to treat macular degeneration. At roughly $1,850 per injection, administered every 4-8 weeks, it has cost Medicare billions. Ophthalmologists who administer it receive both the drug cost and an administration fee.
Other high-cost Part B drugs include chemotherapy agents (pembrolizumab, nivolumab), rheumatoid arthritis biologics (infliximab), and osteoporosis treatments (denosumab).
Read more: Follow the Drug Money →
The Office Visit Economy
Despite all the attention on expensive drugs and procedures, the humble office visit remains Medicare's single largest cost center. Code 99214 (established patient visit, ~25 minutes) alone accounts for $73.3B — more than any drug, surgery, or imaging code.
This reflects the sheer scale of primary care: nearly a billion 99214 visits over 10 years. The average payment of about $73 per visit seems modest, but multiplied by volume, it dwarfs most individual high-cost procedures.