95816
HCPCS Procedure Code
HCPCS code 95816 is the #702 most-billed Medicaid procedure code, with $101.7M in payments across 795K claims from 2018–2024. The national median cost per claim is $56.87. Costs vary widely — the 90th percentile is $261.89 per claim, 4.6× the median.
Total Paid
$101.7M
0.01% of all spending
Total Claims
795K
Providers
2K
Avg Cost/Claim
$128
National Cost Distribution
How much do providers bill per claim for 95816? Based on 2K providers billing this code nationally.
Median
$56.87
Average
$105.13
Std Dev
$104.66
Max
$661.64
Percentile Distribution (Cost per Claim)
50% of providers bill between $26.70 and $161.31 per claim for this code.
90% bill between $15.44 and $261.89.
Top 1% bill above $416.64.
About This Procedure
HCPCS code 95816 was billed by 2K providers across 795K claims, totaling $101.7M in Medicaid payments from 2018–2024. This code was used for 712K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$56.87
Providers Billing
2K
National Spending
$101.7M
Avg/Median Ratio
1.85×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for 95816
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1386731073 | $1.8M |
| 2 | 1497168546 | $1.7M |
| 3 | 1396985222 | $1.5M |
| 4 | University Of Kentucky Lexington, KY · General Acute Care Hospital | $1.4M |
| 5 | North Shore-lij Medical Pc Great Neck, NY · Urology | $1.4M |
| 6 | The Cooper Health System Camden, NJ · General Acute Care Hospital | $1.4M |
| 7 | 1730296047 | $1.3M |
| 8 | 1356459473 | $1.3M |
| 9 | 1720236730 | $1.2M |
| 10 | 1457731242 | $1.2M |
| 11 | 1013998830 | $1.2M |
| 12 | 1063909208 | $1.2M |
| 13 | 1275988321 | $1.1M |
| 14 | 1376967422 | $1.1M |
| 15 | 1881146413 | $1.1M |
| 16 | 1811064520 | $1.1M |
| 17 | 1427165596 | $1.1M |
| 18 | Virginia Commonwealth University Health System Authority Richmond, VA · General Acute Care Hospital | $923K |
| 19 | 1336319086 | $909K |
| 20 | 1326060740 | $822K |
Showing top 20 of 2K providers billing this code