0169
HCPCS Procedure Code
HCPCS code 0169 is the #839 most-billed Medicaid procedure code, with $68.9M in payments across 63K claims from 2018–2024. The national median cost per claim is $400.28. Costs vary widely — the 90th percentile is $4,007.60 per claim, 10.0× the median.
Total Paid
$68.9M
0.01% of all spending
Total Claims
63K
Providers
20
Avg Cost/Claim
$1K
National Cost Distribution
How much do providers bill per claim for 0169? Based on 16 providers billing this code nationally.
Median
$400.28
Average
$1,531.59
Std Dev
$2,055.42
Max
$7,271.38
Percentile Distribution (Cost per Claim)
50% of providers bill between $286.07 and $2,288.05 per claim for this code.
90% bill between $83.61 and $4,007.60.
Top 1% bill above $6,887.40.
About This Procedure
HCPCS code 0169 was billed by 20 providers across 63K claims, totaling $68.9M in Medicaid payments from 2018–2024. This code was used for 23K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$400.28
Providers Billing
16
National Spending
$68.9M
Avg/Median Ratio
3.83×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for 0169
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1467653303 | $32.4M |
| 2 | 1851587224 | $13.9M |
| 3 | 1902839962 | $5.7M |
| 4 | 1720254535 | $4.2M |
| 5 | 1316021942 | $3.5M |
| 6 | 1669622353 | $2.2M |
| 7 | 1437241692 | $1.8M |
| 8 | Ablelight Inc. Watertown, WI · Intermediate Care Facility, Intellectual Disabilities | $1.5M |
| 9 | 1457428427 | $1.0M |
| 10 | 1588730881 | $871K |
| 11 | 1124063763 | $734K |
| 12 | 1861579468 | $712K |
| 13 | 1205857315 | $247K |
| 14 | 1376639609 | $117K |
| 15 | 1114112620 | $28K |
| 16 | 1194808261 | $15K |
| 17 | 1790875441 | $0 |
| 18 | 1346338282 | $0 |
| 19 | 1164501912 | $0 |
| 20 | 1124653126 | $0 |
Showing top 20 of 20 providers billing this code