#1339 of 11K

99305

HCPCS Procedure Code

HCPCS code 99305 is the #1,339 most-billed Medicaid procedure code, with $26.7M in payments across 1.1M claims from 2018–2024. The national median cost per claim is $19.28. Costs vary widely — the 90th percentile is $54.01 per claim, 2.8× the median.

Total Paid

$26.7M

0.00% of all spending

Total Claims

1.1M

Providers

Avg Cost/Claim

$25

National Cost Distribution

How much do providers bill per claim for 99305? Based on 3K providers billing this code nationally.

Median

$19.28

Average

$25.21

Std Dev

$24.37

Max

$554.92

Percentile Distribution (Cost per Claim)

p10

$4.58

p25

$9.68

Median

$19.28

p75

$33.77

p90

$54.01

p95

$67.61

p99

$104.42

50% of providers bill between $9.68 and $33.77 per claim for this code.

90% bill between $4.58 and $54.01.

Top 1% bill above $104.42.

About This Procedure

HCPCS code 99305 was billed by 3K providers across 1.1M claims, totaling $26.7M in Medicaid payments from 2018–2024. This code was used for 917K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$19.28

Providers Billing

National Spending

$26.7M

Avg/Median Ratio

1.31×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 99305

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1578709515	$1.1M	$172.75	9.0× median	Top 1%
2	1407483175	$708K	$15.57	0.8× median	Below Median
3	Maryland Medical First P.a. Baltimore, MD · Internal Medicine	$456K	$58.84	3.1× median	Top 10%
4	1831298751	$428K	$16.41	0.9× median	Below Median
5	1609362375	$383K	$43.01	2.2× median	Above 75th
6	1790983690	$314K	$48.20	2.5× median	Above 75th
7	1588122535	$308K	$34.14	1.8× median	Above 75th
8	1720440449	$295K	$43.35	2.2× median	Above 75th
9	1013052257	$279K	$63.51	3.3× median	Top 10%
10	1124564703	$269K	$60.58	3.1× median	Top 10%
11	1881109452	$255K	$27.71	1.4× median	Above Median
12	1144677568	$238K	$63.31	3.3× median	Top 10%
13	1528379195	$221K	$31.80	1.6× median	Above Median
14	1699728089	$211K	$59.39	3.1× median	Top 10%
15	1851540165	$198K	$44.87	2.3× median	Above 75th
16	1669845327	$183K	$28.64	1.5× median	Above Median
17	Los Angeles County Department Of Mental Health Los Angeles, CA · Clinic/Center, Mental Health (Including Community Mental Health Center)	$176K	$554.92	28.8× median	Top 1%
18	1205887262	$174K	$69.02	3.6× median	Top 10%
19	1659455145	$173K	$29.54	1.5× median	Above Median
20	Parcare Community Health Network Inc Brooklyn, NY · Specialist	$173K	$108.41	5.6× median	Top 1%

Showing top 20 of 3K providers billing this code

Related Procedures

99309Nursing facility care, subsequent, low complexity$781.4M 99308Nursing facility care, subsequent, straightforward$536.4M 99310$148.5M 99307$60.0M 99306$55.8M

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