Revenue from the USA medical coding market was about USD 937.4 Million in 2022, with the USA market estimated to surge ahead at a CAGR of 8.4% to reach a valuation of around USD 2.3 Billion by the end of 2033.
| Attributes | Details |
|---|---|
| USA Medical Coding Market Size (2023) | USD 1.0 Billion |
| Projected Market Value (2033) | USD 2.3 Billion |
| Market Growth Rate (2023 to 2033) | 8.4% CAGR |
| Market Share of Top 3 Regions | 69.4% |
According to Future Market Insights, the emergency medicine segment of the USA medical coding market based on clinical specialties secured a market value of USD 202.1 Million in 2022.
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The market for medical coding market in USA recorded a historic CAGR of 6.9% in the last 7 years from 2015 to 2022.
The market value of the USA medical coding was around 12.9% of the overall ~USD 7.3 Billion of the USA revenue cycle management market in 2022.
Due to the rising prevalence of diseases, there is an increase in patient visits and admissions in healthcare settings. This will lead to increasing demand for rising adoption of digital technologies so that smooth administrative workflow can be achieved within healthcare settings.
Electronic medical records can be very efficiently used in order to check for symptoms, diseases, illnesses, and even causes of death. Apart from this, it helps healthcare professionals to check for previous medical, surgical, and diagnostic procedures that the patient has gone through. In order to facilitate the smooth documenting of medical records and enable accurate medical billing, medical coding software, and services assist in the translation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. The increasing prevalence of diseases will eventually increase the number of patient visits and admissions in healthcare settings, which will require more administrative functionality. Hence, this can be considered an effective driver for the growth of the medical coding market.
The administrative practices of a hospital or any other healthcare setting are the focus of medical coding. Incorrectly manually inputted codes may result in claim denials, which can cost additional money to resolve. The hospital loses out on important revenue if the claim denials are not resolved and it is difficult to get the patient to pay what is owed. To avoid fines and other legal implications, State and Federal regulations must also be followed effortlessly in the USA
This points to the increasing need for medical coding and billing software to help in reducing the chances of these errors. Numerous errors in denied claims may actually be avoided, and by doing so, one can greatly increase collection rates. This points to the increasing use of medical coding software and services hence would impact the USA market in a positive manner.
The USA market is thus likely to show significant growth over the coming years with a CAGR of 8.4%, and reach a market size of around USD 2.3 Billion by 2033.
Introduction and Revisions of Codes
Medical codes are used by healthcare providers and insurance companies for billing and record-keeping purposes. There are three types of medical codes being referred in the USA, the International Classification of Diseases (ICD) Codes, Current Procedural Terminology (CPT) Codes and Healthcare Common Procedure Coding (HCPCS).
For faster coding operations, medical coding software combines knowledge from all the top coding and reference books in one location. Hence, its use and demand are increasing. The introduction and revision of codes can be considered one of the driving factors for the medical coding market in USA
Apart from this, the rising demand for certified medical billers and coders creates lucrative opportunities for this market. Doctors' reports are translated into useful, standardized medical codes by medical coders. These professionals operate behind the scenes in a variety of settings, ensuring that all pertinent data is correctly coded to ensure accuracy and consistency. The insurance company or government provider has to know what was done after a medical professional evaluates or treats a patient in order to process the bill. Because the common language used to describe medical treatments is too imprecise to provide the insurance company with the precise information it requires, a set of precise codes has been created. It is the responsibility of the medical coder to convey this knowledge in a clear and effective manner.
Medical coders are required to possess a certification from the American Health Information Management Association in order to be called certified medical coders. As the horizons of digital health are widening in the USA, the demand for such professionals in the field of healthcare will increase, impacting the USA market for medical coding in a positive manner.
Other than this, the usage of AI in medical coding is considered to be the future because this brings ease to the functioning of medical coders. This presents lucrative opportunities for developers and providers of software and services in the field of medical coding.
Confidentiality and Security Concerns
Medical coders are given access to patient data that is highly confidential, and therefore, concerns regarding data security are quite high in the USA The companies have to comply with HIPAA in order to prove their compliance. This will pose a challenge to the growth of this market.
Other than this, the dearth of trained and certified medical coders is another factor that can restrain the growth of the USA market. Although there are various job positions for medical coders in the USA, the country has faced and is facing a shortage of medical coders for hospitals, physician practices, and other healthcare facilities. It is mostly the northeastern and western parts of the country that have experienced a shortage of trained medical coders. This shortage is due to the lack of awareness regarding the medical record coding professions among various graduates in the USA
Apart from this, the individuals who are currently in the profession are not able to keep up with the continuous updates and changes in the field of medical coding, leading to fewer individuals opting for this profession. This can hamper the growth of the medical coding market in the USA
The emergency medicine segment held around 21.6% share of the total USA market in 2022.
Emergency medicine is a branch of medicine that specializes in providing immediate care for illnesses and injuries. Their area of expertise is the management of unplanned, undifferentiated patients of all ages.
This points to the increasing number of billing generation in emergency medicine and hence increasing the use of medical coding software and solutions in this clinical specialty. This makes emergent medicine the dominant segment among the various clinical specialties of the USA market.
The outsourced segment held around 72.6% share of the USA market in 2022. This segment is expected to surge at a CAGR of 8.6% over the period of 2023 to 2033.
Healthcare providers are increasingly outsourcing their needs for medical coding in order to reduce administrative costs. Time is saved, costs are reduced, and workflow is streamlined by outsourcing. Hence, healthcare practitioners may prioritize the standard of patient care and patient involvement.
Market expansion is being positively impacted by the increase in onshoring and offshoring of revenue cycle management, particularly medical coding. Any hospital or healthcare facility would benefit from the well-known fact that hiring outsourced medical coding workers can reduce administrative expenditures by 25% to 30%. This makes outsourced service the dominant segment of the USA market.
Enterprise therapy practices held a significant share of about 59.0% with a market value of around USD 294.6 Million in 2022. The enterprise therapy practices include hospitals, ambulatory surgical centers, cancer research institutes and long-term care centers. The use of medical coding solutions and software is quite high in facilities like these and therefore enterprise therapy practices held a significant share of the end user segment of the market.
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The focus of leading companies is on expansion and growth in the various regions of this market. Many companies are concentrating on coming up with new software and solutions in the medical coding field and along with this, the companies focus on expansion through acquisitions and partnerships.
For instance:
Similarly, recent developments have been tracked by the team at Future Market Insights related to companies in the USA medical coding space, which are available in the full report.
| Attribute | Details |
|---|---|
| Forecast Period | 2023 to 2033 |
| Historical Data Available for | 2015 to 2022 |
| Market Analysis | USD Million for Value |
| Key Countries Regions | Northeast USA, Midwest USA, Southeast USA, Southwest USA, West USA |
| Key Market Segments Covered | Clinical Specialties, Service, End User and Region |
| Key Companies Profiled | Tebra (Kareo, Inc.); Global Payments, Inc. (AdvancedMD, Inc.); EverCommerce Inc. (DrChrono Inc.); The 3M Company (3M Health Information Systems, Inc.); Greenway Health, LLC; Dolbey; GeBBS Healthcare Solutions (Aviacode Inc.); AQuity; Baruch Business Solutions; Infinx; athenahealth, Inc.; BUDDI.AI; Context4 Healthcare, Inc.; Eclat Health Solutions Inc.; Maverick Medical AI Ltd.; UnitedHealth Group Inc. (Optum, Inc.); NYM; Practolytics; Outsource Strategies International; Datavant (Ciox); PCS (Precyse Coding Solutions, LLC); Novigo Health Care Services; I-conic Solutions |
| Report Coverage | Market Forecast, Competition Intelligence, DROT Analysis, Market Dynamics and Challenges, Strategic Growth Initiatives |
| Customization & Pricing | Available upon Request |
The growth potential of the USA medical coding market is 2.3% through 2033.
The adoption of alternative methods is likely to limit market growth.
The United States is likely to capture a CAGR of 8.4% through 2033.
The current market valuation is USD 1 billion in 2023.
The market is likely to secure a valuation of USD 2.3 billion by 2033.
| Market Value for 2024 | USD 18.82 billion |
|---|---|
| Market Value for 2034 | USD 34.34 billion |
| Market CAGR (2024 to 2034) | 6.20% |
| Market Size (2024) | USD 8,131.3 million |
|---|---|
| Market Value (2034) | USD 16,603.7 million |
| Market Projected CAGR (2024 to 2034) | 7.4% |
| Market Size, 2023 | USD 48,626.2 million |
|---|---|
| Market Size, 2033 | USD 103,052.3 million |
| Value-based CAGR (2023 to 2033) | 7.8% |
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USA Medical Coding Market
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