#1424 of 11K

97152

HCPCS Procedure Code

HCPCS code 97152 is the #1,424 most-billed Medicaid procedure code, with $23.7M in payments across 104K claims from 2018–2024. The national median cost per claim is $155.16. Costs vary widely — the 90th percentile is $338.09 per claim, 2.2× the median.

Total Paid

$23.7M

0.00% of all spending

Total Claims

104K

Providers

Avg Cost/Claim

$228

National Cost Distribution

How much do providers bill per claim for 97152? Based on 91 providers billing this code nationally.

Median

$155.16

Average

$183.25

Std Dev

$150.93

Max

$987.11

Percentile Distribution (Cost per Claim)

p10

$47.47

p25

$90.57

Median

$155.16

p75

$237.69

p90

$338.09

p95

$413.97

p99

$729.41

50% of providers bill between $90.57 and $237.69 per claim for this code.

90% bill between $47.47 and $338.09.

Top 1% bill above $729.41.

About This Procedure

HCPCS code 97152 was billed by 94 providers across 104K claims, totaling $23.7M in Medicaid payments from 2018–2024. This code was used for 28K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$155.16

Providers Billing

National Spending

$23.7M

Avg/Median Ratio

1.18×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 97152

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Children's Crisis Treatment Center Philadelphia, PA · Community/Behavioral Health	$4.1M	$254.19	1.6× median	Above 75th
2	1255870838	$2.9M	$448.53	2.9× median	Top 10%
3	1942398839	$2.4M	$283.50	1.8× median	Above 75th
4	Brett Dinovi & Associates Pa Llc Bensalem, PA · Behavior Analyst	$1.9M	$244.43	1.6× median	Above 75th
5	1992299820	$1.9M	$267.42	1.7× median	Above 75th
6	1366047474	$1.6M	$276.84	1.8× median	Above 75th
7	Abs Utah P.c. Salt Lake City, UT · Community/Behavioral Health	$1.2M	$250.53	1.6× median	Above 75th
8	Positive Behavior Supports Stuart, FL · Community/Behavioral Health	$1.0M	$254.26	1.6× median	Above 75th
9	1881751865	$754K	$261.32	1.7× median	Above 75th
10	1093233264	$603K	$214.01	1.4× median	Above Median
11	1952441701	$594K	$149.37	1.0× median	Below Median
12	1932367638	$471K	$232.79	1.5× median	Above Median
13	1386035079	$380K	$176.96	1.1× median	Above Median
14	1285992743	$365K	$210.61	1.4× median	Above Median
15	1649506940	$335K	$178.59	1.2× median	Above Median
16	Eric Lund Green Bay, WI · Psychologist Clinical	$316K	$89.04	0.6× median	Below Median
17	1770138265	$298K	$360.47	2.3× median	Top 10%
18	1174129563	$210K	$222.85	1.4× median	Above Median
19	1922451657	$198K	$122.71	0.8× median	Below Median
20	Special People In Northeast, Inc. Philadelphia, PA · Clinic/Center, Community Health	$172K	$144.61	0.9× median	Below Median

Showing top 20 of 94 providers billing this code

Related Procedures

97153Adaptive behavior treatment by protocol, per 15 min$5.15B 97155Adaptive behavior treatment with protocol modification, per 15 minutes$1.44B 97150Therapeutic procedure, group (2+ patients)$643.8M 97161Physical therapy evaluation, low complexity$244.8M 97162PT evaluation, moderate complexity$170.3M

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