#1438 of 11K

99404

HCPCS Procedure Code

HCPCS code 99404 is the #1,438 most-billed Medicaid procedure code, with $23.3M in payments across 211K claims from 2018–2024. The national median cost per claim is $104.92.

Total Paid

$23.3M

0.00% of all spending

Total Claims

211K

Providers

272

Avg Cost/Claim

$111

National Cost Distribution

How much do providers bill per claim for 99404? Based on 227 providers billing this code nationally.

Median

$104.92

Average

$107.05

Std Dev

$126.06

Max

$1,760.25

Percentile Distribution (Cost per Claim)

p10

$15.00

p25

$50.12

Median

$104.92

p75

$155.96

p90

$170.10

p95

$177.62

p99

$302.64

50% of providers bill between $50.12 and $155.96 per claim for this code.

90% bill between $15.00 and $170.10.

Top 1% bill above $302.64.

About This Procedure

HCPCS code 99404 was billed by 272 providers across 211K claims, totaling $23.3M in Medicaid payments from 2018–2024. This code was used for 181K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$104.92

Providers Billing

227

National Spending

$23.3M

Avg/Median Ratio

1.02×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 99404

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1821597444	$14.4M	$300.78	2.9× median	Top 10%
2	Family Health Centers Of San Diego, Inc San Diego, CA · Clinic/Center, Federally Qualified Health Center (FQHC)	$773K	$17.09	0.2× median	Below Median
3	Northeast Health Services, Llc Taunton, MA · Clinic/Center, Mental Health (Including Community Mental Health Center)	$704K	$160.47	1.5× median	Above 75th
4	Clinical & Support Options Inc Greenfield, MA · Community/Behavioral Health	$467K	$129.35	1.2× median	Above Median
5	1093225138	$298K	$82.93	0.8× median	Below Median
6	1386085173	$280K	$29.00	0.3× median	Below Median
7	1518996354	$179K	$156.13	1.5× median	Above 75th
8	1326046467	$178K	$93.73	0.9× median	Below Median
9	1538575295	$176K	$142.22	1.4× median	Above Median
10	1164949855	$175K	$96.95	0.9× median	Below Median
11	Nys Office Of Mental Health Orangeburg, NY · Clinic/Center, Adolescent and Children Mental Health	$171K	$225.11	2.1× median	Top 10%
12	1598707002	$159K	$161.46	1.5× median	Above 75th
13	1033402003	$153K	$105.58	1.0× median	Above Median
14	1821068818	$148K	$185.21	1.8× median	Top 10%
15	1225200314	$147K	$172.09	1.6× median	Top 10%
16	Behavioral Health Network Inc Springfield, MA · Clinic/Center Methadone Clinic	$146K	$104.73	1.0× median	Below Median
17	1568127199	$142K	$105.77	1.0× median	Above Median
18	1295942514	$138K	$36.82	0.4× median	Below Median
19	1417959370	$137K	$14.96	0.1× median	Below Median
20	1275866477	$132K	$105.68	1.0× median	Above Median

Showing top 20 of 272 providers billing this code

Related Procedures

99394Preventive medicine, established patient, age 12-17$1.24B 99395Preventive medicine, established patient, age 18-39$469.4M 99396Preventive medicine, established patient, age 40-64$379.0M 99401$122.5M 99402$94.5M

← All procedures Top providers →