99221
Initial hospital care, straightforward/low
Initial hospital care, straightforward/low is the #653 most-billed Medicaid procedure code, with $114.1M in payments across 1.9M claims from 2018–2024. The national median cost per claim is $39.96. Costs vary widely — the 90th percentile is $81.50 per claim, 2.0× the median.
Total Paid
$114.1M
0.01% of all spending
Total Claims
1.9M
Providers
4K
Avg Cost/Claim
$61
National Cost Distribution
How much do providers bill per claim for 99221? Based on 4K providers billing this code nationally.
Median
$39.96
Average
$50.65
Std Dev
$66.10
Max
$1,299.60
Percentile Distribution (Cost per Claim)
50% of providers bill between $24.82 and $58.61 per claim for this code.
90% bill between $14.12 and $81.50.
Top 1% bill above $317.80.
About This Procedure
HCPCS code 99221 (Initial hospital care, straightforward/low) was billed by 4K providers across 1.9M claims, totaling $114.1M in Medicaid payments from 2018–2024. This code was used for 1.6M unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$39.96
Providers Billing
4K
National Spending
$114.1M
Avg/Median Ratio
1.27×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 99221
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1003216391 | $5.2M |
| 2 | 1508873183 | $4.1M |
| 3 | 1073632261 | $3.5M |
| 4 | Seventh-day Adventists Loma Linda University Medical Center Loma Linda, CA · General Acute Care Hospital | $1.8M |
| 5 | 1114958584 | $1.6M |
| 6 | 1528650223 | $1.5M |
| 7 | 1467504555 | $1.3M |
| 8 | Riverside University Health Systems - Medical Center Moreno Valley, CA · General Acute Care Hospital | $1.3M |
| 9 | 1003102781 | $1.3M |
| 10 | Alameda Health System Oakland, CA · General Acute Care Hospital | $1.1M |
| 11 | The Health And Hospital Corporation Of Marion County Indianapolis, IN · Psychiatric Unit | $1.1M |
| 12 | 1013981554 | $1.1M |
| 13 | 1417979204 | $1.1M |
| 14 | 1770522856 | $1.1M |
| 15 | 1992131049 | $1.1M |
| 16 | 1255745287 | $851K |
| 17 | The Nemours Foundation Wilmington, DE · Clinic/Center, Developmental Disabilities | $781K |
| 18 | Loma Linda University Children's Hospital Loma Linda, CA · General Acute Care Hospital Children | $756K |
| 19 | Montefiore Medical Center Bronx, NY · Anesthesiology | $748K |
| 20 | 1295772093 | $735K |
Showing top 20 of 4K providers billing this code