#1304 of 11K

99242

Office consultation, low complexity

Office consultation, low complexity is the #1,304 most-billed Medicaid procedure code, with $28.2M in payments across 483K claims from 2018–2024. The national median cost per claim is $57.97.

Total Paid

$28.2M

0.00% of all spending

Total Claims

483K

Providers

Avg Cost/Claim

$58

National Cost Distribution

How much do providers bill per claim for 99242? Based on 1K providers billing this code nationally.

Median

$57.97

Average

$59.89

Std Dev

$41.15

Max

$859.44

Percentile Distribution (Cost per Claim)

p10

$23.55

p25

$42.22

Median

$57.97

p75

$70.42

p90

$89.47

p95

$110.47

p99

$150.06

50% of providers bill between $42.22 and $70.42 per claim for this code.

90% bill between $23.55 and $89.47.

Top 1% bill above $150.06.

About This Procedure

HCPCS code 99242 (Office consultation, low complexity) was billed by 1K providers across 483K claims, totaling $28.2M in Medicaid payments from 2018–2024. This code was used for 433K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$57.97

Providers Billing

National Spending

$28.2M

Avg/Median Ratio

1.03×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 99242

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Los Angeles County Department Of Mental Health Los Angeles, CA · Clinic/Center, Mental Health (Including Community Mental Health Center)	$3.1M	$516.37	8.9× median	Top 1%
2	1417263922	$1.1M	$47.92	0.8× median	Below Median
3	1669686606	$794K	$65.66	1.1× median	Above Median
4	1609078997	$629K	$67.66	1.2× median	Above Median
5	1083711790	$575K	$121.47	2.1× median	Top 10%
6	1174565600	$500K	$50.06	0.9× median	Below Median
7	1144389230	$461K	$47.94	0.8× median	Below Median
8	Phoenix Children's Hospital Phoenix, AZ · Pediatrics	$434K	$68.51	1.2× median	Above Median
9	Cook Children's Physician Network Fort Worth, TX · Medical Genetics, Clinical Genetics (M.D.)	$411K	$67.59	1.2× median	Above Median
10	1922074434	$393K	$47.18	0.8× median	Below Median
11	1932389715	$363K	$57.24	1.0× median	Below Median
12	1396748950	$325K	$93.55	1.6× median	Top 10%
13	1801856786	$320K	$70.75	1.2× median	Above 75th
14	1457571150	$298K	$83.04	1.4× median	Above 75th
15	1962509109	$297K	$95.34	1.6× median	Top 10%
16	1992746879	$252K	$14.94	0.3× median	Below Median
17	Geisinger Clinic Danville, PA · Surgery	$250K	$55.91	1.0× median	Below Median
18	State Of Mississippi - University Of Mississippi Medical Center Jackson, MS · General Acute Care Hospital	$250K	$53.26	0.9× median	Below Median
19	1760421382	$234K	$71.80	1.2× median	Above 75th
20	1699382507	$213K	$46.72	0.8× median	Below Median

Showing top 20 of 1K providers billing this code

Related Procedures

99232Subsequent hospital care, per day, moderate complexity$2.93B 99233Subsequent hospital care, per day, high complexity$2.61B 99239Hospital discharge day management, more than 30 minutes$464.1M 99244Office or other outpatient consultation, moderate complexity$402.7M 99238Hospital discharge day management, 30 minutes or less$402.6M

← All procedures Top providers →