G0397
HCPCS Procedure Code
HCPCS code G0397 is the #610 most-billed Medicaid procedure code, with $127.4M in payments across 901K claims from 2018–2024. The national median cost per claim is $142.31. Costs vary widely — the 90th percentile is $308.11 per claim, 2.2× the median.
Total Paid
$127.4M
0.01% of all spending
Total Claims
901K
Providers
287
Avg Cost/Claim
$141
National Cost Distribution
How much do providers bill per claim for G0397? Based on 269 providers billing this code nationally.
Median
$142.31
Average
$157.98
Std Dev
$94.74
Max
$519.00
Percentile Distribution (Cost per Claim)
50% of providers bill between $122.37 and $163.43 per claim for this code.
90% bill between $46.09 and $308.11.
Top 1% bill above $459.13.
About This Procedure
HCPCS code G0397 was billed by 287 providers across 901K claims, totaling $127.4M in Medicaid payments from 2018–2024. This code was used for 475K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$142.31
Providers Billing
269
National Spending
$127.4M
Avg/Median Ratio
1.11×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for G0397
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1083618672 | $12.1M |
| 2 | Vertex Llc Bronx, NY · Clinic/Center Rehabilitation Substance Use Disorder | $10.5M |
| 3 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $9.6M |
| 4 | 1134593510 | $7.9M |
| 5 | 1689891178 | $5.0M |
| 6 | 1518918101 | $3.7M |
| 7 | 1033520440 | $2.7M |
| 8 | 1942359476 | $2.6M |
| 9 | Beth Israel Medical Center Brooklyn, NY · Psychiatric Unit | $2.5M |
| 10 | 1669758751 | $2.5M |
| 11 | University Of Rochester Rochester, NY · General Acute Care Hospital | $2.4M |
| 12 | 1134140809 | $2.2M |
| 13 | 1407870827 | $2.0M |
| 14 | 1568568962 | $1.8M |
| 15 | 1497981328 | $1.8M |
| 16 | 1437221355 | $1.7M |
| 17 | 1003824855 | $1.6M |
| 18 | County Of San Diego San Diego, CA · Public Health or Welfare | $1.6M |
| 19 | 1083771232 | $1.5M |
| 20 | 1740366749 | $1.5M |
Showing top 20 of 287 providers billing this code