#1768 of 11K

96138

HCPCS Procedure Code

HCPCS code 96138 is the #1,768 most-billed Medicaid procedure code, with $14.2M in payments across 576K claims from 2018–2024. The national median cost per claim is $19.87.

Total Paid

$14.2M

0.00% of all spending

Total Claims

576K

Providers

791

Avg Cost/Claim

$25

National Cost Distribution

How much do providers bill per claim for 96138? Based on 701 providers billing this code nationally.

Median

$19.87

Average

$25.33

Std Dev

$39.42

Max

$493.73

Percentile Distribution (Cost per Claim)

p10

$2.53

p25

$8.49

Median

$19.87

p75

$30.33

p90

$37.22

p95

$52.32

p99

$185.42

50% of providers bill between $8.49 and $30.33 per claim for this code.

90% bill between $2.53 and $37.22.

Top 1% bill above $185.42.

About This Procedure

HCPCS code 96138 was billed by 791 providers across 576K claims, totaling $14.2M in Medicaid payments from 2018–2024. This code was used for 435K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$19.87

Providers Billing

701

National Spending

$14.2M

Avg/Median Ratio

1.27×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 96138

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1144314576	$1.5M	$140.34	7.1× median	Top 10%
2	1023297710	$1.5M	$168.97	8.5× median	Top 10%
3	1144527003	$1.3M	$18.03	0.9× median	Below Median
4	1619553963	$474K	$65.80	3.3× median	Top 10%
5	1154508414	$355K	$13.16	0.7× median	Below Median
6	1447244256	$327K	$13.31	0.7× median	Below Median
7	1942749387	$326K	$94.85	4.8× median	Top 10%
8	University Of Wisconsin Hospitals And Clinics Authority Madison, WI · General Acute Care Hospital	$291K	$128.96	6.5× median	Top 10%
9	Nationwide Children's Hospital Columbus, OH · General Acute Care Hospital	$272K	$45.79	2.3× median	Top 10%
10	1184661290	$218K	$120.61	6.1× median	Top 10%
11	1528592953	$197K	$16.56	0.8× median	Below Median
12	1487895371	$188K	$187.01	9.4× median	Top 1%
13	Children's Hospital Medical Center Cincinnati, OH · Clinic/Center, Primary Care	$173K	$187.35	9.4× median	Top 1%
14	1124561113	$169K	$27.47	1.4× median	Above Median
15	Children's Hospital Washington, DC · General Acute Care Hospital Children	$160K	$447.88	22.5× median	Top 1%
16	1164451399	$156K	$28.33	1.4× median	Above Median
17	Rector & Visitors Of The University Of Virginia Charlottesville, VA · General Acute Care Hospital	$128K	$79.91	4.0× median	Top 10%
18	1528848934	$123K	$32.09	1.6× median	Above 75th
19	1922198779	$123K	$14.34	0.7× median	Below Median
20	Children's Hospital Medical Center Of Akron Akron, OH · General Acute Care Hospital Children	$122K	$185.42	9.3× median	Top 10%

Showing top 20 of 791 providers billing this code

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