#3693 of 11K

99195

HCPCS Procedure Code

HCPCS code 99195 is the #3,693 most-billed Medicaid procedure code, with $1.3M in payments across 39K claims from 2018–2024. The national median cost per claim is $34.14. Costs vary widely — the 90th percentile is $79.18 per claim, 2.3× the median.

Total Paid

$1.3M

0.00% of all spending

Total Claims

39K

Providers

135

Avg Cost/Claim

$34

National Cost Distribution

How much do providers bill per claim for 99195? Based on 133 providers billing this code nationally.

Median

$34.14

Average

$39.80

Std Dev

$28.64

Max

$125.65

Percentile Distribution (Cost per Claim)

p10

$7.28

p25

$14.81

Median

$34.14

p75

$58.55

p90

$79.18

p95

$99.21

p99

$111.20

50% of providers bill between $14.81 and $58.55 per claim for this code.

90% bill between $7.28 and $79.18.

Top 1% bill above $111.20.

About This Procedure

HCPCS code 99195 was billed by 135 providers across 39K claims, totaling $1.3M in Medicaid payments from 2018–2024. This code was used for 31K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$34.14

Providers Billing

133

National Spending

$1.3M

Avg/Median Ratio

1.17×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 99195

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1295896744	$231K	$82.48	2.4× median	Top 10%
2	1295023547	$75K	$55.35	1.6× median	Above Median
3	1770690695	$71K	$70.23	2.1× median	Above 75th
4	1972776672	$58K	$69.18	2.0× median	Above 75th
5	1427536325	$54K	$38.58	1.1× median	Above Median
6	Childrens Hospital Of The Kings Daughters Inc Norfolk, VA · Social Worker, Clinical	$49K	$60.48	1.8× median	Above 75th
7	Yale New Haven Hospital New Haven, CT · General Acute Care Hospital	$47K	$45.92	1.3× median	Above Median
8	1134686777	$46K	$16.99	0.5× median	Below Median
9	1598171209	$42K	$30.36	0.9× median	Below Median
10	Oakwood Healthcare, Inc. Dearborn, MI · General Acute Care Hospital	$39K	$56.41	1.7× median	Above Median
11	Bakersfield Memorial Hospital Bakersfield, CA · General Acute Care Hospital	$31K	$27.22	0.8× median	Below Median
12	1912973314	$30K	$98.77	2.9× median	Top 10%
13	Long Island Jewish Medical Center New Hyde Park, NY · General Acute Care Hospital	$28K	$68.05	2.0× median	Above 75th
14	1447539374	$26K	$12.47	0.4× median	Below Median
15	1699260083	$25K	$24.16	0.7× median	Below Median
16	Presbyterian Healthcare Services Albuquerque, NM · Emergency Medicine	$24K	$59.85	1.8× median	Above 75th
17	1295747277	$22K	$58.55	1.7× median	Above Median
18	Dana-farber Cancer Institute, Inc. Boston, MA · General Acute Care Hospital	$21K	$28.88	0.8× median	Below Median
19	1578587150	$21K	$56.73	1.7× median	Above Median
20	1528018389	$19K	$47.75	1.4× median	Above Median

Showing top 20 of 135 providers billing this code

Related Procedures

99203Office/outpatient visit, new patient, low-mod complexity$3.23B 99204Office/outpatient visit, new patient, mod-high complexity$2.98B 99199Unlisted special service, procedure, or report$2.24B 99202Office/outpatient visit, new patient, low complexity$549.0M 99205Office/outpatient visit, new patient, high complexity$498.9M

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