The Procedures Growing Fastest in Medicaid
We compared 2019 and 2024 spending for every procedure code in Medicaid. Some codes grew by thousands of percent. The reasons range from policy changes to potential fraud.
S5121: 8,935% growth — What is it?
Code S5121 (Attendant care services, in-home, per 15 min) went from $1.8M in 2019 to $166M in 2024. This is an attendant care code — in-home personal care services. The explosive growth likely reflects states expanding home and community-based services (HCBS) under pandemic-era waivers.
ABA therapy and the Minnesota autism fraud connection
Codes 97151 (Behavior identification assessment) and 97154 (Group adaptive behavior treatment, per 15 min) both grew over 1,500%. These are Applied Behavior Analysis (ABA) therapy codes used for autism treatment. While ABA demand has genuinely increased, these codes are directly connected to the Minnesota autism therapy fraud scandal — one of the largest Medicaid fraud cases in history, with an estimated $100M+ in fraudulent billing. Multiple federal indictments followed in 2023–2024.
Code D2740 (Crown, porcelain/ceramic substrate) grew 2,753%. This dental code's growth likely reflects Medicaid dental coverage expansion — several states added comprehensive adult dental benefits in recent years. Code W1793 (State-defined waiver service) grew 5,085% ($11M → $583M), likely reflecting new state waiver programs.
All 50 Fastest-Growing Procedures
| # | Code | Description | 2019 Spending | 2024 Spending | Growth |
|---|---|---|---|---|---|
| 1 | S5121 | Attendant care services, in-home, per 15 min | $1.8M | $166.3M | +8,934.8% |
| 2 | W1793 | State-defined waiver service | $11.2M | $583.2M | +5,084.9% |
| 3 | S9977 | Home infusion therapy, unspecified | $1.2M | $60.7M | +5,033.3% |
| 4 | 81416 | Exome sequence analysis | $1.1M | $44.6M | +4,048.6% |
| 5 | D2740 | Crown, porcelain/ceramic substrate | $7.1M | $201.6M | +2,752.6% |
| 6 | S9482 | Family stabilization services, per 15 minutes | $3.8M | $94.0M | +2,395.5% |
| 7 | 99199 | Unlisted special service, procedure, or report | $30.3M | $602.6M | +1,886.1% |
| 8 | 97154 | Group adaptive behavior treatment, per 15 min | $1.5M | $29.0M | +1,774.6% |
| 9 | 97151 | Behavior identification assessment | $3.4M | $54.6M | +1,512.2% |
| 10 | T1022 | — | $3.5M | $53.8M | +1,452.1% |
| 11 | T2012 | Habilitation, educational; per 15 min | $22.9M | $259.4M | +1,034.8% |
| 12 | 87634 | — | $1.5M | $16.1M | +960.7% |
| 13 | S5101 | Day care services, adult, per half day | $12.0M | $124.2M | +931% |
| 14 | 81415 | — | $2.6M | $26.1M | +906.1% |
| 15 | 27447 | Total knee replacement surgery, both components | $1.0M | $10.2M | +890.7% |
| 16 | D2950 | — | $2.9M | $27.7M | +859.7% |
| 17 | 0821 | Revenue code, other laboratory services | $5.1M | $48.5M | +844.8% |
| 18 | 81528 | Oncology, colorectal screening, quantitative analysis of stool DNA | $10.0M | $92.9M | +824.6% |
| 19 | S0201 | Partial hospitalization services, per diem | $14.3M | $126.2M | +781.2% |
| 20 | 0760 | — | $1.4M | $11.7M | +729.7% |
| 21 | A0390 | ALS mileage, per mile | $8.2M | $67.7M | +727.8% |
| 22 | J1428 | Eteplirsen (Exondys 51) injection, 10 mg | $2.7M | $22.6M | +727.4% |
| 23 | D2751 | Crown, porcelain fused to predominantly base metal | $11.0M | $88.5M | +702.2% |
| 24 | 97156 | — | $6.1M | $46.6M | +666.6% |
| 25 | 0659 | Revenue code, clinic services | $21.5M | $153.4M | +611.9% |
| 26 | H2034 | Alcohol and/or drug abuse halfway house services, per hour | $24.9M | $174.2M | +598.9% |
| 27 | G0506 | Comprehensive assessment of chronic care management | $1.1M | $7.6M | +584.9% |
| 28 | J9271 | Injection, pembrolizumab, 1 mg | $47.4M | $320.5M | +576% |
| 29 | 0123 | — | $1.4M | $9.0M | +553.3% |
| 30 | W9045 | — | $2.2M | $13.6M | +533.6% |
| 31 | 99348 | — | $2.4M | $14.8M | +525% |
| 32 | H2027 | Psychoeducational service, per 15 minutes | $29.1M | $182.0M | +524.8% |
| 33 | W0500 | Waiver service, state-specific code | $6.3M | $37.1M | +489.5% |
| 34 | S8990 | — | $1.2M | $7.0M | +488.6% |
| 35 | 65778 | — | $1.2M | $7.1M | +480.5% |
| 36 | A4224 | — | $1.6M | $9.3M | +480.1% |
| 37 | 81420 | Fetal chromosomal aneuploidy genomic sequence analysis | $46.3M | $261.5M | +464.7% |
| 38 | D0145 | Oral evaluation for patient under 3 years, counseling | $16.6M | $93.6M | +462.9% |
| 39 | 17380 | — | $1.1M | $6.1M | +453.7% |
| 40 | B4189 | — | $1.6M | $8.9M | +447% |
| 41 | D2954 | — | $3.5M | $18.7M | +438.7% |
| 42 | D1354 | — | $7.1M | $36.9M | +420.8% |
| 43 | D2929 | — | $1.3M | $6.6M | +419.7% |
| 44 | 96116 | Neurobehavioral status examination, first hour | $1.1M | $5.9M | +418.1% |
| 45 | 99484 | — | $1.7M | $8.7M | +417.7% |
| 46 | J2350 | Ocrelizumab (Ocrevus) injection, 1 mg | $16.4M | $84.1M | +412.4% |
| 47 | 97155 | Adaptive behavior treatment with protocol modification, per 15 minutes | $84.3M | $424.7M | +404% |
| 48 | 87640 | — | $1.3M | $6.4M | +395% |
| 49 | Q5104 | — | $1.6M | $8.0M | +393.1% |
| 50 | T2027 | Specialized transportation, waiver, per trip, extra | $10.4M | $50.6M | +388% |
Key Takeaways
- ▸In-home attendant care (S5121) grew 8,935%, reflecting HCBS expansion under pandemic waivers.
- ▸ABA therapy codes (97151, 97154) grew 1,500%+, connected to the Minnesota autism fraud scandal ($100M+ in fraudulent billing).
- ▸Dental code D2740 grew 2,753%, likely reflecting Medicaid dental coverage expansion across states.
- ▸Extreme growth doesn't always mean fraud — policy changes, coverage expansion, and new benefits drive legitimate increases.
Source: HHS Medicaid Provider Spending Data (2018–2024) · 227M records