Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

#238 of 11K

99469

Subsequent intensive care, very low birth weight infant

Subsequent intensive care, very low birth weight infant is the #238 most-billed Medicaid procedure code, with $613.0M in payments across 1.9M claims from 2018–2024. The national median cost per claim is $293.45.

Total Paid

$613.0M

0.06% of all spending

Total Claims

1.9M

Providers

636

Avg Cost/Claim

$328

National Cost Distribution

How much do providers bill per claim for 99469? Based on 635 providers billing this code nationally.

Median

$293.45

Average

$319.84

Std Dev

$191.92

Max

$3,245.36

Percentile Distribution (Cost per Claim)

p10
$196.29
p25
$246.63
Median
$293.45
p75
$360.06
p90
$439.35
p95
$515.58
p99
$634.60

50% of providers bill between $246.63 and $360.06 per claim for this code.

90% bill between $196.29 and $439.35.

Top 1% bill above $634.60.

About This Procedure

HCPCS code 99469 (Subsequent intensive care, very low birth weight infant) was billed by 636 providers across 1.9M claims, totaling $613.0M in Medicaid payments from 2018–2024. This code was used for 540K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$293.45

Providers Billing

635

National Spending

$613.0M

Avg/Median Ratio

1.09×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 99469

#ProviderTotal Paid
11649377359$23.9M
21992802607$20.0M
31619987302$17.0M
4Not Found

Unknown, Unknown · Unknown

$16.3M
51659485761$13.2M
6Magella Medical Associates Billing, Inc.

Round Rock, TX · Obstetrics & Gynecology, Maternal & Fetal Medicine

$12.8M
71609958446$10.7M
81457396541$10.0M
91245898683$9.7M
10Vanderbilt University Medical Center

Nashville, TN · Transplant Surgery

$9.6M
111326091448$9.2M
121720185432$9.1M
131982678496$8.8M
141376831636$8.4M
151972695260$8.2M
161750351375$7.9M
171497852107$7.8M
181780781492$7.6M
191558468256$7.5M
201427031541$7.4M

Showing top 20 of 636 providers billing this code