OBJECTIVES: The prevalence, treatment pathways and financial burden of lateral epicondylitis (LE) on the healthcare system are poorly understood. This study was  designed to estimate prevalence of LE, the frequency of treatments provided, and costs of care from the  payer perspective.  METHODS: The MarketScan Commercial and Medicare databases were queried. Patients presenting with LE (ICD-9 726.32) between 2011 and 2013 were identified. Prevalence of disease was estimated using the MarketScan projection methodology. The frequency and payments for outpatient treatment modalities for all visits and procedures associated with primary vs secondary diagnoses of LE were estimated. Payments were adjusted for inflation and are presented at 2014 price index. To estimate cost of disease per patient, a cohort of patients with at least 12 month medical history was analyzed for all outpatient costs and procedures associated with primary diagnoses of LE. RESULTS: From 2011 to 2013, prevalence of LE ranged from 413 to 429 patients per 100,000 population, with average age of 48.4-49.2 years. Average yearly payments for outpatient treatments ranged from $332.0 (SD: $1,068.7) to 488.99 (SD: $1,284.9), for visits with either primary-only vs primary or secondary diagnoses of LE, respectively. Injections, diagnostic modalities and physical therapy were the most common procedures, observed in 37%, 30% and 28% patients respectively. Longitudinal analyses of patients with LE indicate that 2.7% patients underwent elbow tenotomy within 12 months of index LE diagnosis. However, these patients accounted for 33% of all LE-associated payments within the LE cohort, with yearly cost of care for these patients at average $5,759. Patients requiring surgery had an average 9.5 (SD: 8.9) outpatient visits with a primary diagnosis of LE whereas all other patients had 3.7 (SD: 4.9) visits (p<0.0001). CONCLUSIONS: Treatment modalities and costs associated with LE vary significantly. Patients requiring surgery account for one-third of direct healthcare resource consumption.