99243
Office or other outpatient consultation, low complexity
Office or other outpatient consultation, low complexity is the #469 most-billed Medicaid procedure code, with $203.1M in payments across 2.6M claims from 2018–2024. The national median cost per claim is $82.43.
Total Paid
$203.1M
0.02% of all spending
Total Claims
2.6M
Providers
4K
Avg Cost/Claim
$79
National Cost Distribution
How much do providers bill per claim for 99243? Based on 4K providers billing this code nationally.
Median
$82.43
Average
$81.28
Std Dev
$36.71
Max
$742.40
Percentile Distribution (Cost per Claim)
50% of providers bill between $63.44 and $97.32 per claim for this code.
90% bill between $37.04 and $119.10.
Top 1% bill above $182.68.
About This Procedure
HCPCS code 99243 (Office or other outpatient consultation, low complexity) was billed by 4K providers across 2.6M claims, totaling $203.1M in Medicaid payments from 2018–2024. This code was used for 2.4M unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$82.43
Providers Billing
4K
National Spending
$203.1M
Avg/Median Ratio
0.99×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 99243
| # | Provider | Total Paid |
|---|---|---|
| 1 | Texas Children's Physician Group Houston, TX · Pediatrics | $6.0M |
| 2 | Phoenix Children's Hospital Phoenix, AZ · Pediatrics | $3.6M |
| 3 | The Nemours Foundation Jacksonville, FL · Clinic/Center Multi-Specialty | $3.2M |
| 4 | Cook Children's Physician Network Fort Worth, TX · Medical Genetics, Clinical Genetics (M.D.) | $3.0M |
| 5 | 1184609851 | $2.8M |
| 6 | 1437555265 | $2.4M |
| 7 | 1093768723 | $2.3M |
| 8 | State Of Mississippi - University Of Mississippi Medical Center Jackson, MS · General Acute Care Hospital | $2.1M |
| 9 | 1801856786 | $1.9M |
| 10 | 1780800128 | $1.8M |
| 11 | 1255405460 | $1.7M |
| 12 | Yale University New Haven, CT · Internal Medicine | $1.7M |
| 13 | Los Angeles County Department Of Mental Health Los Angeles, CA · Clinic/Center, Mental Health (Including Community Mental Health Center) | $1.6M |
| 14 | Geisinger Clinic Danville, PA · Surgery | $1.6M |
| 15 | Prisma Health University Medical Group Greenville, SC · Internal Medicine | $1.5M |
| 16 | Spectrum Health Primary Care Partners Grand Rapids, MI · Psychologist, Clinical Child & Adolescent | $1.5M |
| 17 | 1780669200 | $1.4M |
| 18 | 1669448882 | $1.4M |
| 19 | 1861592867 | $1.3M |
| 20 | 1043287469 | $1.3M |
Showing top 20 of 4K providers billing this code