Procedure Explorer

Name: Medicaid Provider Spending Analysis (2018–2024)
License: https://creativecommons.org/publicdomain/zero/1.0/

Every medical procedure billed to Medicaid has a code (HCPCS). These are the 11K most-billed procedure codes, ranked by total payments — $1.09T in total spending from 2018–2024. Click any code to see detailed benchmarks and top providers.

Showing 100 of 11K procedures

#	Procedure	Total Paid	Claims	Providers	Avg/Claim
1	T1019Personal care services, per 15 min	$122.74B	1.1B	10K	$112
2	T1015Clinic visit/encounter, all-inclusive	$49.15B	322.2M	14K	$153
3	T2016Habilitation, residential, waiver; per diem	$34.90B	69.0M	2K	$506
4	99213Office/outpatient visit, est. patient, low-mod complexity	$33.00B	764.3M	164K	$43
5	S5125Attendant care services, per 15 min	$31.34B	398.1M	5K	$79
6	99214Office/outpatient visit, est. patient, mod-high complexity	$29.91B	502.5M	150K	$60
7	99284Emergency dept visit, high complexity	$20.15B	170.7M	21K	$118
8	H2016Comprehensive community support services, per 15 min	$19.75B	60.7M	2K	$325
9	99283Emergency dept visit, moderate complexity	$16.87B	157.9M	20K	$107
10	H2015Comprehensive community support services, per 15 min	$16.47B	109.9M	4K	$150
11	99285Emergency dept visit, high/urgent complexity	$15.10B	111.0M	18K	$136
12	90837Psychotherapy, 60 minutes	$12.07B	127.2M	44K	$95
13	S5102Day care services, adult; per 15 min	$9.34B	111.1M	2K	$84
14	90834Psychotherapy, 45 minutes	$8.82B	108.8M	28K	$81
15	T2021Day habilitation, waiver; per 15 min	$8.65B	55.6M	2K	$156
16	H2017Psychosocial rehabilitation services, per 15 min	$8.54B	78.7M	4K	$109
17	T1017Targeted case management, per 15 min	$8.42B	75.1M	4K	$112
18	T1020Personal care services, per diem	$8.21B	33.5M	1K	$245
19	90999Unlisted dialysis procedure	$7.74B	90.1M	5K	$86
20	A0427Ambulance, ALS emergency transport Level 1	$7.67B	33.5M	6K	$229
21	92507Speech/hearing/language treatment	$7.48B	129.5M	17K	$58
22	H2019Therapeutic behavioral services, per 15 min	$7.47B	69.5M	6K	$107
23	T2033Residential care, NOS; per diem	$7.42B	16.6M	716	$448
24	T1000Private duty/independent nursing service(s)	$7.01B	16.8M	489	$418
25	H2014Skills training & development, per 15 min	$6.76B	60.7M	4K	$111
26	H0004Behavioral health counseling & therapy, per 15 min	$6.55B	73.3M	9K	$89
27	S5140Foster care, adult; per diem	$6.39B	40.9M	440	$156
28	H0020Alcohol/drug services; methadone administration	$6.25B	312.3M	2K	$20
29	97530Therapeutic activities, each 15 min	$6.22B	126.2M	22K	$49
30	A0429Ambulance, BLS emergency transport	$6.06B	31.0M	6K	$195
31	H0019Behavioral health; residential, per diem	$5.98B	20.4M	756	$294
32	T1040Medicaid certified CCBHC services	$5.78B	30.1M	549	$192
33	99509Home visit, assistance w/ ADLs	$5.57B	79.7M	2K	$70
34	00003Anesthesia services	$5.33B	20.2M	693	$264
35	T2023Community transition, waiver; per service	$5.21B	12.6M	1K	$414
36	T1016Case management, each 15 min	$5.21B	98.3M	5K	$53
37	97153Adaptive behavior treatment by protocol, per 15 min	$5.15B	26.0M	2K	$198
38	97110Therapeutic exercises, each 15 min	$4.96B	135.7M	25K	$37
39	S9124Nursing care, in the home; per hour	$4.96B	12.0M	665	$413
40	S5130Homemaker service, NOS; per 15 min	$4.89B	87.6M	3K	$56
41	H2036Alcohol/drug treatment, per hour	$4.70B	18.2M	976	$258
42	T2031Waiver services, not otherwise specified	$4.65B	14.3M	2K	$326
43	H0036Community psychiatric supportive treatment, per 15 min	$4.54B	56.5M	3K	$80
44	G0463Hospital outpatient clinic visit	$4.45B	72.4M	3K	$61
45	S5126Attendant care services, per diem	$4.44B	49.1M	81	$90
46	H0018Behavioral health; short-term residential, per diem	$4.40B	10.7M	1K	$412
47	T2046Habilitation, residential, waiver; per month	$4.19B	14.1M	831	$298
48	U0003Infectious disease detection (COVID-19)	$4.13B	68.7M	6K	$60
49	A0100Non-emergency transportation; per trip	$3.99B	157.0M	2K	$25
50	H2022Community-based wrap-around services, per diem	$3.93B	7.9M	507	$498
51	99212Office/outpatient visit, low complexity	$3.85B	92.3M	49K	$42
52	D0120Periodic oral evaluation, established patient	$3.81B	136.2M	53K	$28
53	H0015Alcohol and/or drug abuse, intensive outpatient, per hour	$3.81B	25.1M	3K	$152
54	T2022Case management, per month	$3.75B	18.4M	1K	$204
55	T2025Waiver services, NOS; per 15 min	$3.63B	20.5M	690	$177
56	D1120Prophylaxis, adult	$3.62B	108.3M	42K	$33
57	90832Psychotherapy, 30 minutes	$3.57B	65.8M	18K	$54
58	H2010Comprehensive medication services, per 15 min	$3.50B	27.5M	1K	$127
59	A0425Ground mileage, per statute mile	$3.45B	121.8M	9K	$28
60	74177CT abdomen and pelvis with contrast	$3.32B	26.9M	9K	$123
61	99203Office/outpatient visit, new patient, low-mod complexity	$3.23B	47.8M	48K	$68
62	H0038Self-help/peer services, per 15 minutes	$3.12B	30.4M	4K	$103
63	80307Drug test, presumptive, by chemistry analyzers	$2.99B	85.5M	8K	$35
64	H0044Supported housing, per diem	$2.98B	3.1M	895	$977
65	99204Office/outpatient visit, new patient, mod-high complexity	$2.98B	32.4M	43K	$92
66	S5150Unskilled respite care, per 15 min	$2.98B	34.5M	1K	$86
67	99232Subsequent hospital care, per day, moderate complexity	$2.93B	96.6M	30K	$30
68	D2392Resin-based composite, two surfaces, posterior	$2.87B	36.2M	27K	$79
69	T2017Habilitation, residential, waiver; 15 min	$2.85B	13.9M	428	$205
70	99215Office/outpatient visit, high complexity	$2.77B	29.6M	30K	$94
71	T1003LPN/LVN services, per 15 minutes	$2.76B	12.4M	1K	$222
72	99392Preventive medicine, established patient, age 1-4	$2.73B	41.4M	20K	$66
73	H2021Community-based wrap-around services, per 15 min	$2.66B	14.3M	1K	$186
74	99233Subsequent hospital care, per day, high complexity	$2.61B	57.6M	22K	$45
75	H0040Assertive community treatment, face-to-face, per 15 minutes	$2.57B	13.2M	599	$195
76	D1110Prophylaxis, adult cleaning	$2.54B	58.3M	44K	$44
77	99282Emergency dept visit, low complexity	$2.53B	24.2M	8K	$104
78	G0156Home health aide services, per visit	$2.49B	49.7M	2K	$50
79	99391Preventive medicine, established patient, infant (under 1)	$2.47B	37.1M	18K	$67
80	H0032Mental health service plan development	$2.44B	20.0M	5K	$122
81	T2003Non-emergency transport; encounter/trip	$2.44B	108.7M	5K	$22
82	96361IV infusion, hydration, each additional hour	$2.42B	21.0M	4K	$115
83	T1018School-based IEP services, per encounter	$2.37B	32.5M	927	$73
84	S9123Nursing care, in the home, by RN, per 15 minutes	$2.34B	9.2M	948	$254
85	W1793State-defined waiver service	$2.26B	13.1M	380	$172
86	G9012Other specified case management service, per 15 minutes	$2.25B	20.9M	2K	$108
87	99199Unlisted special service, procedure, or report	$2.24B	173.3M	4K	$13
88	S5136Companion care, adult, per 15 minutes	$2.24B	6.4M	200	$353
89	S5170Homemaker service, NOS, per diem	$2.24B	122.2M	931	$18
90	D2930Prefabricated stainless steel crown, primary tooth	$2.17B	16.5M	7K	$131
91	G0378Hospital observation service, per hour	$2.16B	12.0M	3K	$179
92	A0130Non-emergency wheelchair van transport	$2.15B	56.3M	2K	$38
93	70450CT head/brain without contrast	$2.13B	35.1M	9K	$61
94	S9484Crisis intervention mental health services, per hour	$2.12B	4.5M	470	$467
95	G9005Coordinated care fee, risk-adjusted, ESRD	$2.08B	12.9M	220	$161
96	H0046Mental health services, not otherwise specified	$2.05B	18.7M	2K	$110
97	93306Echocardiography, transthoracic, complete, with Doppler	$1.99B	20.5M	11K	$97
98	H2012Behavioral health day treatment, per hour	$1.99B	15.4M	1K	$129
99	99393Preventive medicine, established patient, age 5-11	$1.99B	31.4M	22K	$63
100	T2013Habilitation, residential, waiver, per hour	$1.97B	12.2M	254	$161