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市場調查報告書
商品編碼
2040681

美國醫療編碼市場規模、佔有率和趨勢分析報告：按分類系統、組件、醫療專科、最終用途和細分市場預測（2026-2033 年）

U.S. Medical Coding Market Size, Share & Trends Analysis Report By Classification System (ICD, HCPCS, CPT), By Component (In-house, Outsourced), By Medical Specialty (Oncology, Cardiology, Anesthesia), By End Use, And Segment Forecasts, 2026 - 2033
出版日期: | 出版商: Grand View Research | 英文 90 Pages | 商品交期: 2-10個工作天內

價格

美國醫療編碼市場概述

據估計，美國醫療編碼市場在 2025 年的價值為 216 億美元，預計到 2033 年將達到 444 億美元。

預計2026年至2033年間，該市場將以9.6%的複合年成長率成長。發票錯誤、保險詐欺以及對醫療文件的誤讀會導致重大的財務損失。由於醫療計費和收入週期管理不當造成的損失不斷增加，推動了對收入週期管理（包括醫療編碼軟體和服務）的需求。預計這將推動市場成長。

市場促進因素和趨勢

美國門診醫療需求的不斷成長正顯著影響醫療編碼服務的需求。醫院和醫療系統日益重視門診部門，以提高營運效率並應對不斷成長的患者數量。此外，提供整形外科、眼科、胃腸病學和疼痛管理等專科當日手術的門診手術中心（ASC）也大大促進了美國門診醫療的成長。全美有超過6,000家門診手術中心，每年進行超過2,000萬例手術，預計在預測期內，醫療編碼服務的外包需求將持續成長。

此外，CMS持續將外科手術納入符合ASC資格的手術項目清單，從而促進外科服務從住院轉向門診。例如，2025年11月，CMS在符合ASC資格的外科手術及相關服務清單（CPL）中新增了276項外科手術，並在ASC CPL中新增了271個代碼。

此外，美國醫療保健行政交易量的不斷成長是推動醫療保健編碼市場發展的重要因素。例如，根據2023年CAQH指數報告，美國醫療保健產業在2023年處理了超過590億筆行政交易，包括發票提交、資格驗證、理賠狀態查詢和預核准申請。其中，醫療發票提交是醫療保健收入周期管理中最關鍵的流程之一。

此外，人工智慧驅動的醫療編碼技術的發展預計將推動市場成長。例如，2025年4月，克利夫蘭診所與AKASA合作，在其美國醫療機構的中期收入周期運作中部署了一款生成式人工智慧工具，實現了臨床文件的醫療編碼自動化。此人工智慧系統可在1.5分鐘內處理超過100份文檔，提高了速度、準確性和預核准效率，同時也提升了編碼員在處理複雜病例時的工作效率。

美國各地的技術供應商持續投資於先進的人工智慧驅動型醫療編碼平台，這些平台可直接與電子健康記錄系統和收入週期管理軟體整合。 2025年8月，HGM Limited宣布透過其美國子公司Healthcare Capital Holdings LLC (HCH)收購人工智慧驅動型自主編碼解決方案領域的領導企業Aideo Technologies LLC。此次收購將擴展HGM在收入週期管理(RCM)、醫療編碼和醫療分析方面的能力。

目錄

第1章：調查方法和範圍

第2章執行摘要

第3章：美國醫療保健編碼市場：變數、趨勢和範圍

  • 市場區隔和範圍
  • 市場譜系展望
  • 市場趨勢/前景
  • 市場促進因素分析
  • 市場限制因素分析
  • 商業環境分析
  • 案例研究見解

第4章：美國醫療編碼市場：分類系統的估算與趨勢分析

  • 美國醫療編碼市場：分類系統趨勢與市場佔有率分析
  • ICD
  • CPT
  • HCPCS

第5章：美國醫療編碼市場：按組件分類的估算與趨勢分析

  • 美國醫療編碼市場：基於組件的波動分析、市場佔有率分析
  • 內部
  • 外包
    • 陸上
    • 離岸

第6章：美國醫療保健編碼市場：按醫療保健專業分類的估算和趨勢分析

  • 美國醫療編碼市場：波動分析及醫療專業領域市場佔有率分析
  • 腫瘤學
  • 循環系統
  • 麻醉
  • 放射科
  • 疼痛管理
  • 病理
  • 緊急醫療服務
  • 其他

第7章：美國醫療保健編碼市場：按服務類型分類的估算和趨勢分析

  • 美國醫療編碼市場：基於組件的波動分析、市場佔有率分析
  • 急診醫院
    • 住院設施
    • 門診治療
  • 門診手術中心（ASC）

第8章 競爭情勢

  • 參與企業概況
  • 財務業績
  • 公司市場分析
  • 策略規劃
    • 業務拓展
    • 獲得
    • 合夥
    • 新產品發布
    • 夥伴關係
    • 其他
  • 參與企業概況
    • Oracle
    • Maxim Healthcare Services（Amergis）
    • Datavant
    • Aviacode Inc.（GeBBS）
    • Precyse Solutions, LLC
    • Verisk Analytics, Inc.
    • Omega Healthcare Management Services
    • PrimEra Medical Technologies
    • Dolbey
    • 20/20 MD
Product Code: GVR-3-68038-025-5

U.S. Medical Coding Market Summary

The U.S. medical coding market size was estimated at USD 21.6 billion in 2025 and is projected to reach USD 44.4 billion by 2033, growing at a CAGR of 9.6% from 2026 to 2033. Errors in billings, insurance fraud, and misinterpretations of medical documents result in large financial losses. Increasing losses due to ineffective medical billing and revenue cycle management are increasing demand for revenue cycle management including medical coding software and services. This, in turn, is estimated to drive market growth potential.

Market Drivers & Dynamics

The growing preference for outpatient healthcare delivery in the U.S. is significantly influencing the demand for medical coding services. Hospitals and health systems increasingly prioritize outpatient departments to manage rising patient volumes while improving operational efficiency. Moreover, ambulatory surgery centers (ASCs) significantly contribute to the growth of outpatient care in the U.S., providing same-day surgical procedures in specialties such as orthopedics, ophthalmology, gastroenterology, and pain management. With more than 6,000 centers nationwide performing over 20 million procedures annually, outsourcing of medical coding services is expected to rise over the forecast period.

Moreover, CMS continues to add procedures to the ASC-covered list, encouraging migration of surgical services away from inpatient hospital settings. For instance, in November 2025, CMC added 276 procedures to the ASC Covered Surgical Procedures and Ancillary Services Lists (CPL) and added an additional 271 codes to the ASC CPL.

In addition, the growing volume of healthcare administrative transactions in the U.S. is a significant driver of the medical coding market. For instance, according to the 2023 CAQH Index Report, the U.S. healthcare industry processed over 59 billion administrative transactions in 2023, including claims submissions, eligibility checks, claim status inquiries, and prior authorization requests. Among these, medical claims submission represents one of the most critical processes within healthcare revenue cycle management.

Furthermore, development of artificial intelligence (AI)-enabled medical coding is estimated to drive market growth. For instance, in April 2025, the Cleveland Clinic partnered with AKASA to deploy generative AI tools in mid-revenue-cycle operations across U.S. sites, automating medical coding from clinical documents. The AI processes 100+ documents in 1.5 minutes, boosting speed, accuracy, and prior authorizations while enhancing coder efficiency for complex cases.

Technology vendors across the country continue investing in advanced AI-driven medical coding platforms that integrate directly with electronic health record systems and revenue cycle management software. In August 2025, HGM Limited, through its U.S. subsidiary Healthcare Capital Holdings LLC (HCH), announced the acquisition of Aideo Technologies LLC, a leader in AI-powered autonomous coding solutions. This acquisition expands HGM's capabilities in revenue cycle management (RCM), medical coding, and healthcare analytics.

U.S. Medical Coding Market Report Segmentation

This report forecasts revenue growth at the country level and provides an analysis of latest industry trends in each of the sub-segments from 2021 to 2033. For this study, Grand View Research, Inc. has segmented the U.S. medical coding market report based on classification system, component, medical specialty, and end use:

  • Classification System Outlook (Revenue, USD Million, 2021 - 2033)
  • ICD
  • HCPCS
  • CPT
  • Component Outlook (Revenue, USD Million, 2021 - 2033)
  • In-house
  • Outsourced
    • Onshore
    • Offshore
  • Medical Specialty Outlook (Revenue, USD Million, 2021 - 2033)
  • Oncology
  • Cardiology
  • Anesthesia
  • Radiology
  • Pathology
  • Pain Management
  • Emergency Services
  • Others
  • End Use Outlook (Revenue, USD Million, 2021 - 2033)
  • Acute Care Hospitals
    • Inpatient Settings
    • Outpatient Settings
  • Ambulatory Surgery Centers (ASC)

Table of Contents

Chapter 1. Methodology and Scope

  • 1.1. Market Segmentation & Scope
  • 1.2. Market Definitions
    • 1.2.1. Classification System Segment
    • 1.2.2. Component Segment
    • 1.2.3. Medical Specialty Segment
    • 1.2.4. End Use Segment
  • 1.3. Information analysis
    • 1.3.1. Market formulation & data visualization
  • 1.4. Data validation & publishing
  • 1.5. Information Procurement
    • 1.5.1. Primary Research
  • 1.6. Information or Data Analysis
  • 1.7. Market Formulation & Validation
  • 1.8. Market Model
  • 1.9. Total Market: CAGR Calculation
  • 1.10. Objectives
    • 1.10.1. Objective 1
    • 1.10.2. Objective 2

Chapter 2. Executive Summary

  • 2.1. Market Outlook
  • 2.2. Segment Snapshot
  • 2.3. Competitive Insights Landscape

Chapter 3. U.S. Medical Coding Market Variables, Trends, & Scope

  • 3.1. Market Segmentation and Scope
  • 3.2. Market Lineage Outlook
    • 3.2.1. Parent Market Outlook
    • 3.2.2. Related/Ancillary Market Outlook
  • 3.3. Market Trends and Outlook
  • 3.4. Market Driver Analysis
  • 3.5. Market Restraint Analysis
  • 3.6. Business Environment Analysis
    • 3.6.1. PESTLE Analysis
    • 3.6.2. Porter's Five Forces Analysis
  • 3.7. Case Study Insights

Chapter 4. U.S. Medical Coding Market: Classification System Estimates & Trend Analysis

  • 4.1. U.S. Medical Coding Market: Classification System Movement and Market Share Analysis
  • 4.2. U.S. Medical Coding Classification System Market: Segment Dashboard
  • 4.3. ICD
    • 4.3.1. ICD Market, 2021 - 2033 (USD Million)
  • 4.4. CPT
    • 4.4.1. CPT Market, 2021 - 2033 (USD Million)
  • 4.5. HCPCS
    • 4.5.1. HCPCS Market, 2021 - 2033 (USD Million)

Chapter 5. U.S. Medical Coding Market: Component Estimates & Trend Analysis

  • 5.1. U.S. Medical Coding Market: Component Movement and Market Share Analysis
  • 5.2. U.S. Medical Coding Component Market: Segment Dashboard
  • 5.3. In-house
    • 5.3.1. In-house Market, 2021 - 2033 (USD Million)
  • 5.4. Outsourced
    • 5.4.1. Outsourced Market, 2021 - 2033 (USD Million)
    • 5.4.2. Onshore
      • 5.4.2.1. Onshore Market, 2021 - 2033 (USD Million)
    • 5.4.3. Offshore
      • 5.4.3.1. Offshore Market, 2021 - 2033 (USD Million)

Chapter 6. U.S. Medical Coding Market: Medical Specialty Estimates & Trend Analysis

  • 6.1. U.S. Medical Coding Market: Medical Specialty Movement and Market Share Analysis
  • 6.2. U.S. Medical Coding Medical Specialty Market: Segment Dashboard
  • 6.3. Oncology
    • 6.3.1. Oncology Market, 2021 - 2033 (USD Million)
  • 6.4. Cardiology
    • 6.4.1. Cardiology Market, 2021 - 2033 (USD Million)
  • 6.5. Anesthesia
    • 6.5.1. Anesthesia Market, 2021 - 2033 (USD Million)
  • 6.6. Radiology
    • 6.6.1. Radiology Market, 2021 - 2033 (USD Million)
  • 6.7. Pain Management
    • 6.7.1. Pain Management Market, 2021 - 2033 (USD Million)
  • 6.8. Pathology
    • 6.8.1. Pathology Market, 2021 - 2033 (USD Million)
  • 6.9. Emergency Services
    • 6.9.1. Emergency Services Market, 2021 - 2033 (USD Million)
  • 6.10. Others
    • 6.10.1. Others Market, 2021 - 2033 (USD Million)

Chapter 7. U.S. Medical Coding Market: Services Estimates & Trend Analysis

  • 7.1. U.S. Medical Coding Market: Component Movement and Market Share Analysis
  • 7.2. U.S. Medical Coding Component Market: Segment Dashboard
  • 7.3. Acute Care Hospitals
    • 7.3.1. Acute Care Hospitals Market, 2021 - 2033 (USD Million)
    • 7.3.2. Inpatient Settings
      • 7.3.2.1. Inpatient Settings Market, 2021 - 2033 (USD Million)
    • 7.3.3. Outpatient Settings
      • 7.3.3.1. Outpatient Settings Market, 2021 - 2033 (USD Million)
  • 7.4. Ambulatory Surgery Centers (ASC)
    • 7.4.1. Ambulatory Surgery Centers (ASC) Market, 2021 - 2033 (USD Million)

Chapter 8. Competitive Landscape

  • 8.1. Participant's Overview
  • 8.2. Financial Performance
  • 8.3. Company Market Position Analysis
  • 8.4. Strategy Mapping
    • 8.4.1. Expansion
    • 8.4.2. Acquisition
    • 8.4.3. Collaborations
    • 8.4.4. New Product Launches
    • 8.4.5. Partnerships
    • 8.4.6. Others
  • 8.5. Participant's overview
    • 8.5.1. Oracle
      • 8.5.1.1. Overview
      • 8.5.1.2. Financial Performance
      • 8.5.1.3. Product Benchmarking
      • 8.5.1.4. Strategic Initiatives
    • 8.5.2. Maxim Healthcare Services (Amergis)
      • 8.5.2.1. Overview
      • 8.5.2.2. Financial Performance
      • 8.5.2.3. Product Benchmarking
      • 8.5.2.4. Strategic Initiatives
    • 8.5.3. Datavant
      • 8.5.3.1. Overview
      • 8.5.3.2. Financial Performance
      • 8.5.3.3. Product Benchmarking
      • 8.5.3.4. Strategic Initiatives
    • 8.5.4. Aviacode Inc. (GeBBS)
      • 8.5.4.1. Overview
      • 8.5.4.2. Financial Performance
      • 8.5.4.3. Product Benchmarking
      • 8.5.4.4. Strategic Initiatives
    • 8.5.5. Precyse Solutions, LLC
      • 8.5.5.1. Overview
      • 8.5.5.2. Financial Performance
      • 8.5.5.3. Product Benchmarking
      • 8.5.5.4. Strategic Initiatives
    • 8.5.6. Verisk Analytics, Inc.
      • 8.5.6.1. Overview
      • 8.5.6.2. Financial Performance
      • 8.5.6.3. Product Benchmarking
      • 8.5.6.4. Strategic Initiatives
    • 8.5.7. Omega Healthcare Management Services
      • 8.5.7.1. Overview
      • 8.5.7.2. Financial Performance
      • 8.5.7.3. Product Benchmarking
      • 8.5.7.4. Strategic Initiatives
    • 8.5.8. PrimEra Medical Technologies
      • 8.5.8.1. Overview
      • 8.5.8.2. Financial Performance
      • 8.5.8.3. Product Benchmarking
      • 8.5.8.4. Strategic Initiatives
    • 8.5.9. Dolbey
      • 8.5.9.1. Overview
      • 8.5.9.2. Financial Performance
      • 8.5.9.3. Product Benchmarking
      • 8.5.9.4. Strategic Initiatives
    • 8.5.10. 20/20 MD
      • 8.5.10.1. Overview
      • 8.5.10.2. Financial Performance
      • 8.5.10.3. Product Benchmarking
      • 8.5.10.4. Strategic Initiatives

List of Tables

  • Table 1. List of secondary sources
  • Table 2. List of abbreviations
  • Table 3. U.S. medical coding market, by classification system, 2021 - 2033 (USD Million)
  • Table 4. U.S. medical coding market, by component, 2021 - 2033 (USD Million)
  • Table 6. U.S. medical coding market, by medical specialty, 2021 - 2033 (USD Million)
  • Table 5. U.S. medical coding market, by end use, 2021 - 2033 (USD Million)

List of Figures

  • Fig. 1 Market research process
  • Fig. 2 Information procurement
  • Fig. 3 Primary research pattern
  • Fig. 4 Market research approaches
  • Fig. 5 Value chain-based sizing & forecasting
  • Fig. 6 Market formulation & validation
  • Fig. 7 Practice management system market segmentation
  • Fig. 8 Market snapshot, 2025
  • Fig. 9 Market trends & outlook
  • Fig. 10 Market driver relevance analysis (current & future impact)
  • Fig. 11 Market restraint relevance analysis (current & future impact)
  • Fig. 12 PESTLE analysis
  • Fig. 13 Porter's five forces analysis
  • Fig. 14 U.S. medical coding market: Component movement and market share analysis
  • Fig. 15 U.S. medical coding market component outlook: Segment dashboard
  • Fig. 16 In-house market, 2021 - 2033 (USD Million)
  • Fig. 17 Outsourced market, 2021 - 2033 (USD Million)
  • Fig. 18 Onshore market, 2021 - 2033 (USD Million)
  • Fig. 19 Offshore market, 2021 - 2033 (USD Million)
  • Fig. 20 U.S. medical coding market: Classification system movement and market share analysis
  • Fig. 21 U.S. medical coding market classification system outlook: Segment dashboard
  • Fig. 22 ICD market, 2021 - 2033 (USD Million)
  • Fig. 23 CPT market, 2021 - 2033 (USD Million)
  • Fig. 24 HCPCS market, 2021 - 2033 (USD Million)
  • Fig. 25 U.S. medical coding market: Medical specialty movement and market share analysis
  • Fig. 26 U.S. medical coding market medical specialty outlook: Segment dashboard
  • Fig. 27 Cardiology market, 2021 - 2033 (USD Million)
  • Fig. 28 Oncology market, 2021 - 2033 (USD Million)
  • Fig. 29 Anesthesia market, 2021 - 2033 (USD Million)
  • Fig. 30 Radiology market, 2021 - 2033 (USD Million)
  • Fig. 31 Pathology market, 2021 - 2033 (USD Million)
  • Fig. 32 Pain Management market, 2021 - 2033 (USD Million)
  • Fig. 33 Emergency Services market, 2021 - 2033 (USD Million)
  • Fig. 34 Others market, 2021 - 2033 (USD Million)
  • Fig. 35 U.S. medical coding market: End-use movement and market share analysis
  • Fig. 36 U.S. medical coding market end-use outlook: Segment dashboard
  • Fig. 37 Acute care hospitals market, 2021 - 2033 (USD Million)
  • Fig. 38 Inpatient Settings market, 2021 - 2033 (USD Million)
  • Fig. 39 Outpatient settings market, 2021 - 2033 (USD Million)
  • Fig. 40 Ambulatory Surgery Centers (ASC) market, 2021 - 2033 (USD Million)
  • Fig. 41 Company market position analysis
  • Fig. 42 Company/competition categorization
  • Fig. 43 Strategy mapping