97016
HCPCS Procedure Code
HCPCS code 97016 is the #1,995 most-billed Medicaid procedure code, with $10.4M in payments across 824K claims from 2018–2024. The national median cost per claim is $8.30. Costs vary widely — the 90th percentile is $28.95 per claim, 3.5× the median.
Total Paid
$10.4M
0.00% of all spending
Total Claims
824K
Providers
497
Avg Cost/Claim
$13
National Cost Distribution
How much do providers bill per claim for 97016? Based on 452 providers billing this code nationally.
Median
$8.30
Average
$13.41
Std Dev
$17.37
Max
$202.73
Percentile Distribution (Cost per Claim)
50% of providers bill between $5.67 and $15.87 per claim for this code.
90% bill between $2.24 and $28.95.
Top 1% bill above $91.46.
About This Procedure
HCPCS code 97016 was billed by 497 providers across 824K claims, totaling $10.4M in Medicaid payments from 2018–2024. This code was used for 235K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$8.30
Providers Billing
452
National Spending
$10.4M
Avg/Median Ratio
1.62×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for 97016
| # | Provider | Total Paid |
|---|---|---|
| 1 | District Hospital Partners L P Washington, DC · Nurse Practitioner, Family | $906K |
| 2 | 1528061827 | $326K |
| 3 | 1528628633 | $322K |
| 4 | Virginia Commonwealth University Health System Authority Richmond, VA · General Acute Care Hospital | $312K |
| 5 | 1891407235 | $253K |
| 6 | Ohio State University Hospitals Columbus, OH · General Acute Care Hospital | $228K |
| 7 | 1164851085 | $200K |
| 8 | 1306557491 | $198K |
| 9 | 1760193858 | $190K |
| 10 | 1528848934 | $189K |
| 11 | 1528569316 | $188K |
| 12 | 1417646860 | $165K |
| 13 | Mercy Health - St Vincent Medical Center Llc Toledo, OH · Ambulance, Land Transport | $164K |
| 14 | 1518017144 | $161K |
| 15 | 1962276980 | $154K |
| 16 | 1477332880 | $153K |
| 17 | 1538304050 | $149K |
| 18 | University Of Kentucky Lexington, KY · General Acute Care Hospital | $145K |
| 19 | 1790493401 | $144K |
| 20 | 1295419638 | $132K |
Showing top 20 of 497 providers billing this code