Six years after COVID-19 hit, the billing patterns of American physicians still haven't returned to their pre-pandemic baseline. For some specialties and procedures, the pandemic didn't just cause a temporary dip. It caused a permanent reset.

The 2020 Collapse Was Steep, But Uneven

The scale of the 2020 drop in Medicare billing is easy to understate. The most-billed procedure code in the dataset, the standard 25-minute established patient office visit (99214), lost 18 million services between 2019 and 2020. A single billing code, declining by roughly the volume of a mid-sized city's annual doctor visits in one year.

But the recovery was uneven. That same office visit code recovered most of its volume by 2022, landing just 8% below its 2019 level. The 15-minute established patient visit (99213) did not: it remained 20.7% below 2019 levels by 2022, only partially recovered. Two codes for the same basic encounter type, diverging sharply. Patients who returned to in-person care may have been sicker, or more complex, requiring longer visits.

Some codes never came back at all. Injections of aprepitant (an anti-nausea drug used in chemotherapy) were down 47.1% from 2019 levels by 2022. Factor VIII, used to treat hemophilia, dropped 58.5% and hadn't recovered. Chest X-rays fell 40.8% and stayed there. These aren't elective procedures that patients chose to skip. Their persistent absence from Medicare billing suggests something structural shifted in how and where these services are delivered.

Cardiac Surgery and Anesthesiology Are Still Waiting

Specialty-level payment data tells a similar story of selective, incomplete recovery.

Cardiac surgery's trajectory is striking. Payments fell 28.2% in 2020 and then kept falling. By 2023, the specialty was collecting 41.1% less from Medicare than it did in 2019. That's not a pandemic disruption. That's a restructured market. Anesthesiology and CRNAs show nearly identical patterns: a sharp 2020 drop followed by essentially no recovery through 2023, with both specialties sitting roughly 19-22% below their pre-pandemic baselines.

Physical therapy went the opposite direction. After a 19.3% drop in 2020, physical therapists in private practice had grown their Medicare payments to 17.2% above 2019 levels by 2023. That's a full recovery plus additional growth, worth more than $485 million in additional annual payments compared to the pre-pandemic baseline.

Provider Counts Kept Growing, Even When Billing Didn't

One number cuts against the narrative of a shrinking Medicare ecosystem. The total number of unique providers billing Medicare fell only modestly in 2020, dropping by 8,054 (a 0.74% decline) from 1,093,367 in 2019. By 2021, the count had not only recovered but grown by 38,276 providers in a single year. By 2023, 1,175,281 unique providers were billing Medicare, the highest count in the dataset.

More providers billing Medicare, but some specialties collecting substantially less. That gap matters for understanding what's happening at the practice level. Providers stayed in the system, but the mix of services they delivered, and the payments they received, shifted in ways that haven't fully unwound.

The question that the data keeps circling back to: when a specialty like cardiac surgery is still 41% below its 2019 Medicare payment levels in 2023, with no sign of closing that gap, at what point does "not yet recovered" become "this is the new baseline"?