96161
HCPCS Procedure Code
HCPCS code 96161 is the #1,311 most-billed Medicaid procedure code, with $27.8M in payments across 4.3M claims from 2018–2024. The national median cost per claim is $2.49. Costs vary widely — the 90th percentile is $8.59 per claim, 3.4× the median.
Total Paid
$27.8M
0.00% of all spending
Total Claims
4.3M
Providers
4K
Avg Cost/Claim
$6
National Cost Distribution
How much do providers bill per claim for 96161? Based on 3K providers billing this code nationally.
Median
$2.49
Average
$4.55
Std Dev
$10.81
Max
$256.33
Percentile Distribution (Cost per Claim)
50% of providers bill between $1.40 and $3.80 per claim for this code.
90% bill between $0.28 and $8.59.
Top 1% bill above $41.69.
About This Procedure
HCPCS code 96161 was billed by 4K providers across 4.3M claims, totaling $27.8M in Medicaid payments from 2018–2024. This code was used for 3.8M unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$2.49
Providers Billing
3K
National Spending
$27.8M
Avg/Median Ratio
1.83×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for 96161
| # | Provider | Total Paid |
|---|---|---|
| 1 | Nationwide Children's Hospital Columbus, OH · General Acute Care Hospital | $7.3M |
| 2 | The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital | $1.4M |
| 3 | 1740242957 | $442K |
| 4 | Childrens Hospital Of The Kings Daughters Inc Norfolk, VA · Social Worker, Clinical | $433K |
| 5 | 1235350901 | $419K |
| 6 | Virginia Commonwealth University Health System Authority Richmond, VA · General Acute Care Hospital | $402K |
| 7 | Children's Hospital Medical Center Cincinnati, OH · Clinic/Center, Primary Care | $399K |
| 8 | 1184016941 | $335K |
| 9 | Maimonides Medical Center Brooklyn, NY · General Acute Care Hospital | $308K |
| 10 | Children's Hospital Medical Center Of Akron Akron, OH · General Acute Care Hospital Children | $307K |
| 11 | 1053612911 | $251K |
| 12 | 1437168135 | $241K |
| 13 | 1649727447 | $222K |
| 14 | 1235180480 | $210K |
| 15 | 1982686614 | $205K |
| 16 | 1518138916 | $198K |
| 17 | 1609046267 | $194K |
| 18 | 1063459410 | $173K |
| 19 | 1548349186 | $167K |
| 20 | New York City Health And Hospitals Corporation Brooklyn, NY · Internal Medicine | $161K |
Showing top 20 of 4K providers billing this code