Introduction:
The purpose of this study was to characterize the availability of high-resolution anoscopy (HRA) services in the United States using Medicare claims data.

Methods:
Data were from 2013-2021 Provider Utilization and Payment Data provided by the Centers for Medicare & Medicaid Services. We identified three CPT codes (46600, 46601, 46607) associated with HRA procedures, achieving a sensitivity of 94.7% when compared to a provider list from the Anal Neoplasia Clinic, Research, and Education Center. We geocoded claims data to the county level and merged it with HIV incidence data. Counties were categorized by HRA availability: 0 = none, 1 = anoscopy unspecified HRA, and 2 = specified HRA based on billing codes. Descriptive analyses were performed in R.

Results:
Of 1,505,820 clinicians, 0.18% had unspecified HRA and 0.008% had specified HRA. Colorectal surgeons accounted for 47.3% of HRA providers, followed by general surgeons (25.1%) and gastroenterologists (10.6%). Mean HIV rates were higher in counties with specified HRA (660/100,000) compared to those without (159/100,000). County HIV-rates were not associated with availability of HRA providers. In states with the highest quartile of HIV incidence, counties without HRA availability were most prevalent in Georgia (109 counties), Texas (78 counties), and Mississippi (61 counties).

Conclusions:
HRA availability is limited nationwide, with notable gaps in the South. These findings highlight critical disparities in access and the need for targeted interventions to expand HRA services in underserved regions.