99201
Office/outpatient visit, new patient, straightforward
Office/outpatient visit, new patient, straightforward is the #713 most-billed Medicaid procedure code, with $99.2M in payments across 1.5M claims from 2018–2024. The national median cost per claim is $27.38. Costs vary widely — the 90th percentile is $109.08 per claim, 4.0× the median.
Total Paid
$99.2M
0.01% of all spending
Total Claims
1.5M
Providers
3K
Avg Cost/Claim
$67
National Cost Distribution
How much do providers bill per claim for 99201? Based on 2K providers billing this code nationally.
Median
$27.38
Average
$45.50
Std Dev
$54.63
Max
$462.85
Percentile Distribution (Cost per Claim)
50% of providers bill between $17.07 and $48.28 per claim for this code.
90% bill between $5.27 and $109.08.
Top 1% bill above $342.53.
About This Procedure
HCPCS code 99201 (Office/outpatient visit, new patient, straightforward) was billed by 3K providers across 1.5M claims, totaling $99.2M in Medicaid payments from 2018–2024. This code was used for 1.3M unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$27.38
Providers Billing
2K
National Spending
$99.2M
Avg/Median Ratio
1.66×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for 99201
| # | Provider | Total Paid |
|---|---|---|
| 1 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $21.0M |
| 2 | 1639278369 | $4.3M |
| 3 | Regents Of The University Of California Sacramento, CA · General Acute Care Hospital | $2.4M |
| 4 | 1134152549 | $2.1M |
| 5 | 1477671535 | $2.0M |
| 6 | 1598993198 | $1.5M |
| 7 | 1457317398 | $1.3M |
| 8 | The General Hospital Corporation Boston, MA · General Acute Care Hospital | $1.3M |
| 9 | Parcare Community Health Network Inc Brooklyn, NY · Specialist | $1.2M |
| 10 | 1821147786 | $1.1M |
| 11 | 1235120676 | $1.1M |
| 12 | 1396725677 | $1.1M |
| 13 | 1740413798 | $1.0M |
| 14 | 1922116037 | $935K |
| 15 | North Shore Lij Urgent Care P.c. Rockville Centre, NY · Clinic/Center Urgent Care | $763K |
| 16 | 1821092206 | $760K |
| 17 | Children's Hospital & Research Center At Oakland Oakland, CA · General Acute Care Hospital | $750K |
| 18 | Stanford Health Care Stanford, CA · General Acute Care Hospital | $712K |
| 19 | 1366686248 | $696K |
| 20 | 1518996040 | $670K |
Showing top 20 of 3K providers billing this code