#958 of 11K

Q9991

HCPCS Procedure Code

HCPCS code Q9991 is the #958 most-billed Medicaid procedure code, with $54.3M in payments across 40K claims from 2018–2024. The national median cost per claim is $1,554.42.

Total Paid

$54.3M

0.00% of all spending

Total Claims

40K

Providers

Avg Cost/Claim

$1K

National Cost Distribution

How much do providers bill per claim for Q9991? Based on 57 providers billing this code nationally.

Median

$1,554.42

Average

$1,272.21

Std Dev

$657.04

Max

$2,205.64

Percentile Distribution (Cost per Claim)

p10

$11.56

p25

$910.76

Median

$1,554.42

p75

$1,773.97

p90

$1,841.25

p95

$1,942.16

p99

$2,114.61

50% of providers bill between $910.76 and $1,773.97 per claim for this code.

90% bill between $11.56 and $1,841.25.

Top 1% bill above $2,114.61.

About This Procedure

HCPCS code Q9991 was billed by 63 providers across 40K claims, totaling $54.3M in Medicaid payments from 2018–2024. This code was used for 35K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$1,554.42

Providers Billing

National Spending

$54.3M

Avg/Median Ratio

0.82×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for Q9991

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Accredo Health Group Inc Memphis, TN · Pharmacy	$12.0M	$1,554.42	1.0× median	Above Median
2	1083045140	$4.9M	$1,464.17	0.9× median	Below Median
3	Orsini Pharmaceutical Services Llc Elk Grove Village, IL · Pharmacy Specialty Pharmacy	$3.7M	$1,398.40	0.9× median	Below Median
4	1942453220	$3.6M	$1,795.99	1.2× median	Above 75th
5	Spectrum Health Primary Care Partners Grand Rapids, MI · Psychologist, Clinical Child & Adolescent	$3.1M	$1,557.43	1.0× median	Above Median
6	1811206071	$3.0M	$1,631.87	1.0× median	Above Median
7	1497776454	$2.5M	$1,945.19	1.3× median	Top 10%
8	1154321545	$2.2M	$1,403.17	0.9× median	Below Median
9	1043387152	$1.7M	$1,581.79	1.0× median	Above Median
10	1013994359	$1.4M	$1,385.20	0.9× median	Below Median
11	1013456383	$1.2M	$1,643.40	1.1× median	Above Median
12	1801495544	$1.1M	$1,825.47	1.2× median	Above 75th
13	Mainehealth Portland, ME · Emergency Medicine	$987K	$1,578.98	1.0× median	Above Median
14	Mainegeneral Medical Center Augusta, ME · General Acute Care Hospital	$973K	$1,616.70	1.0× median	Above Median
15	Boston Medical Center Corporation Boston, MA · General Acute Care Hospital	$945K	$774.14	0.5× median	Below Median
16	Procare Pharmacy Direct, Llc. Monroeville, PA · Pharmacy, Community/Retail Pharmacy	$930K	$1,788.24	1.2× median	Above 75th
17	1598086928	$902K	$910.76	0.6× median	Below Median
18	1588726236	$901K	$1,773.97	1.1× median	Above Median
19	1700834587	$900K	$1,623.80	1.0× median	Above Median
20	1013998913	$885K	$1,816.91	1.2× median	Above 75th

Showing top 20 of 63 providers billing this code

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