96165
Health behavior intervention, family, each additional fifteen minutes
Health behavior intervention, family, each additional fifteen minutes is the #510 most-billed Medicaid procedure code, with $176.7M in payments across 3.1M claims from 2018–2024. The national median cost per claim is $15.54. Costs vary widely — the 90th percentile is $79.94 per claim, 5.1× the median.
Total Paid
$176.7M
0.02% of all spending
Total Claims
3.1M
Providers
537
Avg Cost/Claim
$58
National Cost Distribution
How much do providers bill per claim for 96165? Based on 506 providers billing this code nationally.
Median
$15.54
Average
$33.15
Std Dev
$37.58
Max
$234.03
Percentile Distribution (Cost per Claim)
50% of providers bill between $4.82 and $54.11 per claim for this code.
90% bill between $2.22 and $79.94.
Top 1% bill above $189.78.
About This Procedure
HCPCS code 96165 (Health behavior intervention, family, each additional fifteen minutes) was billed by 537 providers across 3.1M claims, totaling $176.7M in Medicaid payments from 2018–2024. This code was used for 830K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$15.54
Providers Billing
506
National Spending
$176.7M
Avg/Median Ratio
2.13×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for 96165
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1629409867 | $12.0M |
| 2 | Council Bluffs Community School District Council Bluffs, IA · Local Education Agency (LEA) | $7.5M |
| 3 | 1164586210 | $7.5M |
| 4 | 1033426739 | $6.8M |
| 5 | 1639693781 | $6.7M |
| 6 | 1588869093 | $6.3M |
| 7 | 1518186600 | $5.7M |
| 8 | Goodwill Industries Of Northern New England Portland, ME · Clinic/Center Rehabilitation Comprehensive Outpatient Rehabilitation Facility (CORF) | $5.3M |
| 9 | 1518019868 | $4.2M |
| 10 | 1669645073 | $3.9M |
| 11 | 1518094788 | $3.8M |
| 12 | 1790153682 | $3.3M |
| 13 | 1598812141 | $2.9M |
| 14 | 1124159157 | $2.8M |
| 15 | 1376696096 | $2.5M |
| 16 | 1689892473 | $2.5M |
| 17 | 1467505602 | $2.3M |
| 18 | 1376695320 | $2.3M |
| 19 | 1801018528 | $2.2M |
| 20 | 1548306210 | $1.9M |
Showing top 20 of 537 providers billing this code