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Assessment of Trends in Utilization of Nasal Endoscopy in the Medicare Population, 2000-2016. Importance: Nasal endoscopy is the most highly reimbursed routine clinical procedure in otolaryngology by Medicare. To our knowledge, the economic and demographic characteristics of nasal endoscopy have not been characterized at a population level. Objective: To quantify trends in use of nasal endoscopy among Medicare recipients at a national and state level. Design, Setting, and Participants: Cross-sectional study of procedure and beneficiary data from January 1, 2000, to December 31, 2016, and available health care provider data from 2015 obtained from the Centers for Medicare & Medicaid Services for all diagnostic nasal endoscopies categorized as Current Procedural Terminology code 31231. Exposures: Diagnostic nasal endoscopy. Main Outcomes and Measures: Nasal endoscopies were analyzed by state, medical or surgical specialty, mean reimbursement, health care provider density, and type of health care practitioner performing the procedure. Results: The Centers for Medicare & Medicaid Services reimbursed $86.3 million for 559 547 nasal endoscopies in 2016. The total number of nasal endoscopies increased 313%, from 135 494 in 2000 to 559 547 in 2016 (9.3% average annual rate of increase). The mean reimbursement rate per nasal endoscopy varied by state, from $114.25 in Puerto Rico to $189.53 in New York. The percentage of Medicare beneficiaries receiving nasal endoscopy per state ranged from 0.1% in Alaska to 1.7% in New York. Almost all nasal endoscopies were performed by physicians (97.3%), with otolaryngologists (97.2%) being the most common specialty. Reimbursement rates (r = 0.60) and density of health care providers (r = -0.56) were correlated with higher utilization in a state's Medicare population. Conclusions and Relevance: Utilization of nasal endoscopy by otolaryngologists in the Medicare population appears to have increased substantially over the past 2 decades. Practice patterns and reimbursement appeared to vary across the United States.