#396 of 11K

99231

Subsequent hospital care, per day, low complexity

Subsequent hospital care, per day, low complexity is the #396 most-billed Medicaid procedure code, with $274.3M in payments across 13.0M claims from 2018–2024. The national median cost per claim is $16.77. Costs vary widely — the 90th percentile is $33.61 per claim, 2.0× the median.

Total Paid

$274.3M

0.03% of all spending

Total Claims

13.0M

Providers

Avg Cost/Claim

$21

National Cost Distribution

How much do providers bill per claim for 99231? Based on 8K providers billing this code nationally.

Median

$16.77

Average

$20.10

Std Dev

$30.29

Max

$946.73

Percentile Distribution (Cost per Claim)

p10

$5.74

p25

$10.33

Median

$16.77

p75

$24.42

p90

$33.61

p95

$39.97

p99

$67.21

50% of providers bill between $10.33 and $24.42 per claim for this code.

90% bill between $5.74 and $33.61.

Top 1% bill above $67.21.

About This Procedure

HCPCS code 99231 (Subsequent hospital care, per day, low complexity) was billed by 8K providers across 13.0M claims, totaling $274.3M in Medicaid payments from 2018–2024. This code was used for 5.2M unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$16.77

Providers Billing

National Spending

$274.3M

Avg/Median Ratio

1.20×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 99231

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Children's Hospital & Research Center At Oakland Oakland, CA · General Acute Care Hospital	$9.0M	$42.59	2.5× median	Top 10%
2	Alameda Health System Oakland, CA · General Acute Care Hospital	$5.2M	$41.07	2.4× median	Top 10%
3	County Of Riverside Riverside, CA · Community/Behavioral Health	$5.1M	$601.75	35.9× median	Top 1%
4	Los Angeles County Department Of Mental Health Los Angeles, CA · Clinic/Center, Mental Health (Including Community Mental Health Center)	$3.6M	$429.38	25.6× median	Top 1%
5	1801817150	$3.1M	$24.69	1.5× median	Above 75th
6	1578641924	$2.9M	$22.13	1.3× median	Above Median
7	1750466892	$2.5M	$27.56	1.6× median	Above 75th
8	1508803388	$2.2M	$14.20	0.8× median	Below Median
9	County Of Stanislaus Modesto, CA · Community/Behavioral Health	$1.8M	$835.10	49.8× median	Top 1%
10	1700894466	$1.6M	$20.75	1.2× median	Above Median
11	1417979204	$1.6M	$22.43	1.3× median	Above Median
12	Hennepin Healthcare System Inc Minneapolis, MN · General Acute Care Hospital	$1.6M	$31.09	1.9× median	Above 75th
13	1255745287	$1.5M	$24.54	1.5× median	Above 75th
14	1346759768	$1.4M	$314.45	18.8× median	Top 1%
15	Lsu Health Sciences Center Shreveport Faculty Group Practice Shreveport, LA · Oral & Maxillofacial Surgery	$1.4M	$25.16	1.5× median	Above 75th
16	1871549949	$1.4M	$25.83	1.5× median	Above 75th
17	1447206420	$1.3M	$17.15	1.0× median	Above Median
18	1336605849	$1.3M	$22.14	1.3× median	Above Median
19	1396739165	$1.3M	$28.84	1.7× median	Above 75th
20	1700112224	$1.2M	$25.17	1.5× median	Above 75th

Showing top 20 of 8K providers billing this code

Related Procedures

99232Subsequent hospital care, per day, moderate complexity$2.93B 99233Subsequent hospital care, per day, high complexity$2.61B 99223Initial hospital care, per day, high complexity$1.33B 99222Initial hospital care, per day, moderate complexity$491.4M 99239Hospital discharge day management, more than 30 minutes$464.1M

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