#5297 of 11K

97157

HCPCS Procedure Code

HCPCS code 97157 is the #5,297 most-billed Medicaid procedure code, with $238K in payments across 4K claims from 2018–2024. The national median cost per claim is $43.58. Costs vary widely — the 90th percentile is $147.05 per claim, 3.4× the median.

Total Paid

$238K

0.00% of all spending

Total Claims

Providers

Avg Cost/Claim

$61

National Cost Distribution

How much do providers bill per claim for 97157? Based on 30 providers billing this code nationally.

Median

$43.58

Average

$68.26

Std Dev

$56.62

Max

$215.01

Percentile Distribution (Cost per Claim)

p10

$19.84

p25

$26.89

Median

$43.58

p75

$108.32

p90

$147.05

p95

$187.77

p99

$207.13

50% of providers bill between $26.89 and $108.32 per claim for this code.

90% bill between $19.84 and $147.05.

Top 1% bill above $207.13.

About This Procedure

HCPCS code 97157 was billed by 30 providers across 4K claims, totaling $238K in Medicaid payments from 2018–2024. This code was used for 2K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$43.58

Providers Billing

National Spending

$238K

Avg/Median Ratio

1.57×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for 97157

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1912448671	$73K	$115.74	2.7× median	Above 75th
2	Comprehab Llc Gastonia, NC · Speech-Language Pathologist,	$28K	$38.85	0.9× median	Below Median
3	1598117947	$18K	$117.00	2.7× median	Above 75th
4	1457597668	$17K	$187.72	4.3× median	Top 10%
5	1427642032	$17K	$100.80	2.3× median	Above Median
6	1972046027	$17K	$142.53	3.3× median	Above 75th
7	1912069303	$7K	$41.91	1.0× median	Below Median
8	1265736615	$7K	$187.82	4.3× median	Top 10%
9	1740211333	$5K	$119.38	2.7× median	Above 75th
10	1801289020	$5K	$19.61	0.4× median	Below Median
11	1295360154	$5K	$20.10	0.5× median	Below Median
12	1104303775	$4K	$18.69	0.4× median	Below Median
13	1295491280	$4K	$110.83	2.5× median	Above 75th
14	1023415692	$3K	$34.43	0.8× median	Below Median
15	1467598730	$3K	$30.41	0.7× median	Below Median
16	1528145844	$3K	$44.83	1.0× median	Above Median
17	1528437050	$3K	$13.00	0.3× median	Below Median
18	1881729796	$3K	$215.01	4.9× median	Top 1%
19	1609363183	$3K	$40.76	0.9× median	Below Median
20	1437290129	$2K	$53.06	1.2× median	Above Median

Showing top 20 of 30 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

← All procedures Top providers →