USD 16.79 billion
U.S. Medical Coding Market Size, Share, Growth Analysis, By Classification system(ICD, HCPS and CPT), By Component(In-house and outsourced) - Industry Forecast 2024-2031
Report ID:
SQMIG35G2210 |
Region:
Global |
Published Date: February, 2024
Pages:
157
|
Tables:
60 |
Figures:
75
U.S. Medical Coding Market Insights
The U.S. Medical Coding Market size was valued at USD 18.4 billion in 2022 and is poised to grow from USD 20.17 billion in 2023 to USD 41.99 billion by 2031, growing at a CAGR of 9.6% in the forecast period (2024-2031).
The U.S. medical coding market is poised for significant growth in the foreseeable future. Large financial losses occur as a result of billing errors, insurance fraud, and misinterpretations of medical documents. The growing prevalence of ineffective medical billing and revenue cycle management has created a higher demand for revenue cycle management solutions, including medical coding software and services. The adoption of digital technologies such as electronic health records, revenue cycle management software, mhealth applications, telehealth, and the ongoing efforts towards healthcare digitalization in the U.S. are also contributing to the positive expansion of the market. Medical coding is being increasingly employed in the revenue cycle management process, with new code revisions introduced to enhance flexibility and scalability. The implementation of the new ICD-11 coding system in January 2022, featuring numerous new chapters and support for electronic health records, is having a favorable impact on market growth. This revised coding system comprises approximately 55 thousand codes for the classification of disorders, diseases, injuries, and deaths. The Bureau of Labor Statistics, Office of Occupational Statistics and Employment Projections, estimates a 7% growth in the number of medical records and health information employees between 2021 and 2031. Certified medical coders are highly sought-after in the U.S., as there is an increasing demand for standardized medical documentation. The rising workload on healthcare staff and physicians for medical coding has led to the adoption of various automation solutions. For instance, a survey conducted by Athenahealth reveals that physicians spend an average of 90 minutes working overtime on coding. Consequently, there has been a rise in the utilization of computer-assisted coding solutions, which offer rapid, accurate, and efficient medical coding. According to a survey by 3M, computer-assisted coding can increase productivity by 11-30%. Additionally, the development of AI-enabled medical coding is projected to drive market growth. Healthcare spending in the U.S. is experiencing rapid growth, and hospital administration costs are notably high. As a result, healthcare organizations are under increasing pressure to deliver quality care while reducing costs. To address this challenge, healthcare providers are adopting medical coding software and outsourcing services, aiming to decrease administration costs and enhance return on investment. This adoption is anticipated to drive the market's growth.
US Medical Coding Market is poised to grow at a sustainable CAGR for the next forecast year
Market snapshot - 2024-2031
Global Market Size
Largest Segment
ICD
Fastest Growth
ICD
Growth Rate
9.6% CAGR
U.S. Medical Coding Market ($ Bn)
Country Share for U.S. Region (%)
U.S. Medical Coding Market By Classification System ($ Bn)
U.S. Medical Coding Market By Classification System (%)
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U.S. Medical Coding Market Segmental Analysis
The U.S. Medical Coding Market is segmented by classification system, component, and region. Based on classification system, the market can be segmented into ICD, HCPS and CPT. Based on component, the market is segmented into In-house and outsourced. Based on region, the market is segmented into US, Canada, Mexico and rest of North America.
Analysis by Classification System
The market is witnessing a significant revenue share from the use of ICD codes, making ICD the dominant player in the market. The implementation of ICD 11, which became effective on January 1, 2022, has contributed to its success due to its accuracy and flexibility. This coding system enables health information to be utilized for various purposes, including improving patient outcomes, analyzing quality and safety, integrating care, strategic planning, population health reporting, and delivering healthcare services. The user-friendly nature of ICD 11 codes allows for seamless integration into local digital records and information technology systems, resulting in improved user compliance, reduced training costs, and time. The segment is further bolstered by the availability of multiple ICD codes and revisions to accommodate the rapidly evolving healthcare industry.
On the other hand, the CPT segment is expected to experience the highest growth rate during the forecast period. CPT codes, which are a subset of HCPCS codes, are used to describe medical tests, surgeries, and other procedures for the purpose of medical billing. These codes are closely monitored by the government to assess disease prevalence and healthcare spending. HCPCS codes, including CPT codes, are mandatory under the Health Insurance Portability and Accountability Act (HIPAA) in the United States, which has driven their widespread adoption by Medicaid, Medicare, and third-party insurers.
Analysis by Component
The dominant component in the market is the in-house segment, which involves organizations managing the revenue cycle management processes internally. This approach allows companies to have direct control over the billing and coding operations, ensuring greater transparency and customization according to their specific needs. In-house revenue cycle management provides organizations with the flexibility to tailor their strategies, workflows, and technology solutions based on their unique requirements, resulting in efficient and streamlined operations.
On the other hand, the fastest-growing component in the market is the outsourced segment. Many healthcare providers are recognizing the benefits of outsourcing revenue cycle management services to specialized third-party vendors. Outsourcing enables organizations to leverage the expertise and resources of external partners who have in-depth knowledge of medical coding, billing, and revenue cycle management. By outsourcing these functions, healthcare providers can focus more on core patient care activities while reducing administrative burdens and costs. Additionally, outsourcing can provide access to advanced technologies and industry best practices, leading to improved efficiency, accuracy, and financial performance. As a result, the outsourced revenue cycle management segment is experiencing rapid growth in the market.
U.S. Medical Coding Market By Classification System, 2023 (%)
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U.S. Medical Coding Market Regional Insights
The US has a highly developed healthcare system and a large market for revenue cycle management solutions. Factors such as increasing healthcare spending, a complex reimbursement landscape, and a strong focus on digitization and technology adoption in healthcare contribute to the dominance of the US market. Furthermore, the presence of major healthcare organizations, advanced infrastructure, and a favorable regulatory environment for revenue cycle management drive market growth in the US.
On the other hand, the fastest-growing region in the market is Mexico. The country is experiencing rapid growth in their healthcare sectors, driven by factors such as increasing healthcare investments, government initiatives to enhance healthcare infrastructure, and the adoption of advanced technologies. The growing awareness of revenue cycle management solutions and the need for efficient healthcare operations are propelling the market's growth in Mexico. Additionally, the implementation of healthcare reforms and the emphasis on improving patient care and financial outcomes are creating opportunities for revenue cycle management providers in Mexico.
U.S. Medical Coding Market By Geography, 2024-2031
- Largest
- Fastest
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U.S. Medical Coding Market Dynamics
Drivers
Increasing demand for accurate and standardized medical documentation
- One key driver of the U.S. medical coding market is the increasing demand for accurate and standardized medical documentation. The healthcare industry relies on medical coding to ensure proper billing, reimbursement, and communication between healthcare providers and payers. With the growing emphasis on electronic health records and the need for streamlined healthcare processes, the demand for medical coding services and solutions has significantly increased.
Restraints
Complexity and constant evolution of coding systems and regulations
- One key restraint of the U.S. medical coding market is the complexity and constant evolution of coding systems and regulations. Medical coding involves the use of various coding systems, such as ICD (International Classification of Diseases) and CPT (Current Procedural Terminology), which require extensive training and expertise. Additionally, these coding systems undergo regular updates and revisions, making it challenging for coders to stay updated and compliant with the latest coding guidelines. The complexity and dynamic nature of medical coding can pose a barrier to market growth and create challenges for healthcare organizations and coders.
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U.S. Medical Coding Market Competitive Landscape
The competitive landscape of the U.S. medical coding market is characterized by a diverse range of service providers and software solutions catering to the growing demand for accurate and efficient medical coding processes. Key players in the market offer a variety of services, including medical coding software, outsourcing services, consulting, and training. These providers strive to differentiate themselves by offering advanced technologies, user-friendly interfaces, and comprehensive solutions that address the evolving needs of healthcare organizations. Additionally, partnerships and collaborations with healthcare stakeholders, such as hospitals, clinics, and insurance companies, are common strategies to enhance market presence and expand service offerings. As the market continues to grow, competition intensifies, driving innovation and the development of sophisticated coding solutions to meet the demands of the dynamic healthcare industry.
Top Player’s Company Profiles
- Parexel International Corporation
- Aviacode Inc.
- Verisk Analytics, Inc.
- Medical Record Associates, LLC.
- Optum
- Change Healthcare
- Exela Technologies
- nThrive
- Maxim Health Information Services
- himagine solutions Inc.
- M*Modal
- TrustHCS
- Dolbey
- The Coding Network LLC
- MRA Health Information Services
- Peak Health Solutions
- ezDI Inc.
Recent Development
- In February 2024, Maverick Medical AI, or Maverick, a provider of innovative and autonomous AI-powered medical coding platform, has partnered with ImagineSoftware, the leading provider of revenue cycle management (RCM) technology in the U.S. Through the partnership, ImagineSoftware will integrate Maverick’s AI-powered Autonomous Medical Coding Platform as a solution for customers to scale their operations and achieve a higher direct-to-bill rate.
- In February 2024, XpertDox, a pioneer in autonomous AI-enabled medical coding, announced its strategic partnership with Cucamonga Valley Medical Group, Inc. (CVMG), a top-tier primary care organization from California. This collaboration introduces XpertCoding, XpertDox's AI medical coding software, into CVMG's healthcare coding operations across all facilities and providers, revolutionizing their coding quality and revenue cycle process.
- In January 2024, Maverick Medical AI, or Maverick, partnered with Dexios, a radiology-specific revenue-cycle management (RCM) company serving imaging centers and hospital-based radiologists throughout the U.S. Through this partnership, Dexios integrates Maverick’s AI-powered Autonomous Medical Coding Platform to augment its medical coding team, boost productivity, and achieve a higher direct-to-bill rate.
U.S. Medical Coding Key Market Trends
- One key market trend in the U.S. medical coding market is the increasing adoption of automation and artificial intelligence (AI) technologies. Healthcare organizations are leveraging advanced coding software and AI-powered tools to streamline the coding process, enhance accuracy, and improve productivity. Automation solutions, such as computer-assisted coding (CAC), are being widely adopted to assist coders in efficiently assigning appropriate codes to medical procedures and diagnoses. AI algorithms are being used to analyze medical documentation, extract relevant information, and suggest appropriate codes, reducing manual effort and potential errors. This trend is driven by the need for faster and more accurate coding processes, increased efficiency, and improved revenue cycle management in the healthcare industry.
U.S. Medical Coding Market SkyQuest Analysis
SkyQuest’s ABIRAW (Advanced Business Intelligence, Research & Analysis Wing) is our Business Information Services team that Collects, Collates, Co-relates, and Analyses the Data collected by means of Primary Exploratory Research backed by robust Secondary Desk research.
According to our U.S. Medical Coding Market analysis, medical coding plays a crucial role in the healthcare industry, ensuring accurate billing, reimbursement, and efficient medical documentation. The market is driven by factors such as the increasing adoption of electronic health records, the demand for standardized coding systems, and the growing emphasis on revenue cycle management. Key trends in the market include the adoption of automation and AI technologies to streamline coding processes and enhance accuracy. The market is characterized by a diverse range of service providers and software solutions, offering coding software, outsourcing services, and consulting. As healthcare providers strive to optimize financial processes and reduce administrative costs, the demand for medical coding software and outsourcing services is expected to continue growing. Additionally, the complexity and constant evolution of coding systems pose challenges for coders and healthcare organizations, highlighting the importance of continuous training and staying updated with coding guidelines.
| Report Metric | Details |
|---|---|
| Market size value in 2023 | USD 16.79 billion |
| Market size value in 2031 | USD 38.31 billion |
| Growth Rate | 9.6% |
| Forecast period | 2024-2031 |
| Forecast Unit (Value) | USD Billion |
| Segments covered |
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| Regions covered | North America (US, Canada), Europe (Germany, France, United Kingdom, Italy, Spain, Rest of Europe), Asia Pacific (China, India, Japan, Rest of Asia-Pacific), Latin America (Brazil, Rest of Latin America), Middle East & Africa (South Africa, GCC Countries, Rest of MEA) |
| Companies covered |
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| Customization scope | Free report customization with purchase. Customization includes:-
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Table Of Content
Executive Summary
Market overview
- Exhibit: Executive Summary – Chart on Market Overview
- Exhibit: Executive Summary – Data Table on Market Overview
- Exhibit: Executive Summary – Chart on U.S. Medical Coding Market Characteristics
- Exhibit: Executive Summary – Chart on Market by Geography
- Exhibit: Executive Summary – Chart on Market Segmentation
- Exhibit: Executive Summary – Chart on Incremental Growth
- Exhibit: Executive Summary – Data Table on Incremental Growth
- Exhibit: Executive Summary – Chart on Vendor Market Positioning
Parent Market Analysis
Market overview
Market size
- Market Dynamics
- Exhibit: Impact analysis of DROC, 2021
- Drivers
- Opportunities
- Restraints
- Challenges
- Exhibit: Impact analysis of DROC, 2021
- SWOT Analysis
KEY MARKET INSIGHTS
- Technology Analysis
- (Exhibit: Data Table: Name of technology and details)
- Pricing Analysis
- (Exhibit: Data Table: Name of technology and pricing details)
- Supply Chain Analysis
- (Exhibit: Detailed Supply Chain Presentation)
- Value Chain Analysis
- (Exhibit: Detailed Value Chain Presentation)
- Ecosystem Of the Market
- Exhibit: Parent Market Ecosystem Market Analysis
- Exhibit: Market Characteristics of Parent Market
- IP Analysis
- (Exhibit: Data Table: Name of product/technology, patents filed, inventor/company name, acquiring firm)
- Trade Analysis
- (Exhibit: Data Table: Import and Export data details)
- Startup Analysis
- (Exhibit: Data Table: Emerging startups details)
- Raw Material Analysis
- (Exhibit: Data Table: Mapping of key raw materials)
- Innovation Matrix
- (Exhibit: Positioning Matrix: Mapping of new and existing technologies)
- Pipeline product Analysis
- (Exhibit: Data Table: Name of companies and pipeline products, regional mapping)
- Macroeconomic Indicators
COVID IMPACT
- Introduction
- Impact On Economy—scenario Assessment
- Exhibit: Data on GDP - Year-over-year growth 2016-2022 (%)
- Revised Market Size
- Exhibit: Data Table on U.S. Medical Coding Market size and forecast 2021-2027 ($ million)
- Impact Of COVID On Key Segments
- Exhibit: Data Table on Segment Market size and forecast 2021-2027 ($ million)
- COVID Strategies By Company
- Exhibit: Analysis on key strategies adopted by companies
MARKET DYNAMICS & OUTLOOK
- Market Dynamics
- Exhibit: Impact analysis of DROC, 2021
- Drivers
- Opportunities
- Restraints
- Challenges
- Exhibit: Impact analysis of DROC, 2021
- Regulatory Landscape
- Exhibit: Data Table on regulation from different region
- SWOT Analysis
- Porters Analysis
- Competitive rivalry
- Exhibit: Competitive rivalry Impact of key factors, 2021
- Threat of substitute products
- Exhibit: Threat of Substitute Products Impact of key factors, 2021
- Bargaining power of buyers
- Exhibit: buyers bargaining power Impact of key factors, 2021
- Threat of new entrants
- Exhibit: Threat of new entrants Impact of key factors, 2021
- Bargaining power of suppliers
- Exhibit: Threat of suppliers bargaining power Impact of key factors, 2021
- Competitive rivalry
- Skyquest special insights on future disruptions
- Political Impact
- Economic impact
- Social Impact
- Technical Impact
- Environmental Impact
- Legal Impact
Market Size by Region
- Chart on Market share by geography 2021-2027 (%)
- Data Table on Market share by geography 2021-2027(%)
- North America
- Chart on Market share by country 2021-2027 (%)
- Data Table on Market share by country 2021-2027(%)
- USA
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- Canada
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- Europe
- Chart on Market share by country 2021-2027 (%)
- Data Table on Market share by country 2021-2027(%)
- Germany
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- Spain
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- France
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- UK
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- Rest of Europe
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- Asia Pacific
- Chart on Market share by country 2021-2027 (%)
- Data Table on Market share by country 2021-2027(%)
- China
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- India
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- Japan
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- South Korea
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- Rest of Asia Pacific
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- Latin America
- Chart on Market share by country 2021-2027 (%)
- Data Table on Market share by country 2021-2027(%)
- Brazil
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- Rest of South America
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- Middle East & Africa (MEA)
- Chart on Market share by country 2021-2027 (%)
- Data Table on Market share by country 2021-2027(%)
- GCC Countries
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- South Africa
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
- Rest of MEA
- Exhibit: Chart on Market share 2021-2027 (%)
- Exhibit: Market size and forecast 2021-2027 ($ million)
KEY COMPANY PROFILES
- Competitive Landscape
- Total number of companies covered
- Exhibit: companies covered in the report, 2021
- Top companies market positioning
- Exhibit: company positioning matrix, 2021
- Top companies market Share
- Exhibit: Pie chart analysis on company market share, 2021(%)
- Total number of companies covered
Methodology
For the U.S. Medical Coding Market, our research methodology involved a mixture of primary and secondary data sources. Key steps involved in the research process are listed below:
1. Information Procurement: This stage involved the procurement of Market data or related information via primary and secondary sources. The various secondary sources used included various company websites, annual reports, trade databases, and paid databases such as Hoover's, Bloomberg Business, Factiva, and Avention. Our team did 45 primary interactions Globally which included several stakeholders such as manufacturers, customers, key opinion leaders, etc. Overall, information procurement was one of the most extensive stages in our research process.
2. Information Analysis: This step involved triangulation of data through bottom-up and top-down approaches to estimate and validate the total size and future estimate of the U.S. Medical Coding Market.
3. Report Formulation: The final step entailed the placement of data points in appropriate Market spaces in an attempt to deduce viable conclusions.
4. Validation & Publishing: Validation is the most important step in the process. Validation & re-validation via an intricately designed process helped us finalize data points to be used for final calculations. The final Market estimates and forecasts were then aligned and sent to our panel of industry experts for validation of data. Once the validation was done the report was sent to our Quality Assurance team to ensure adherence to style guides, consistency & design.
Analyst Support
Customization Options
With the given market data, our dedicated team of analysts can offer you the following customization options are available for the U.S. Medical Coding Market:
Product Analysis: Product matrix, which offers a detailed comparison of the product portfolio of companies.
Regional Analysis: Further analysis of the U.S. Medical Coding Market for additional countries.
Competitive Analysis: Detailed analysis and profiling of additional Market players & comparative analysis of competitive products.
Go to Market Strategy: Find the high-growth channels to invest your marketing efforts and increase your customer base.
Innovation Mapping: Identify racial solutions and innovation, connected to deep ecosystems of innovators, start-ups, academics, and strategic partners.
Category Intelligence: Customized intelligence that is relevant to their supply Markets will enable them to make smarter sourcing decisions and improve their category management.
Public Company Transcript Analysis: To improve the investment performance by generating new alpha and making better-informed decisions.
Social Media Listening: To analyze the conversations and trends happening not just around your brand, but around your industry as a whole, and use those insights to make better Marketing decisions.
U.S. Medical Coding Market Report Snapshots
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