#389 of 11K

S5165

Home modifications, per service

Home modifications, per service is the #389 most-billed Medicaid procedure code, with $278.7M in payments across 401K claims from 2018–2024. The national median cost per claim is $2,196.32. Costs vary widely — the 90th percentile is $5,039.51 per claim, 2.3× the median.

Total Paid

$278.7M

0.03% of all spending

Total Claims

401K

Providers

224

Avg Cost/Claim

$695

National Cost Distribution

How much do providers bill per claim for S5165? Based on 209 providers billing this code nationally.

Median

$2,196.32

Average

$2,544.27

Std Dev

$2,586.76

Max

$12,199.56

Percentile Distribution (Cost per Claim)

p10

$142.35

p25

$327.01

Median

$2,196.32

p75

$3,718.70

p90

$5,039.51

p95

$8,422.57

p99

$11,685.51

50% of providers bill between $327.01 and $3,718.70 per claim for this code.

90% bill between $142.35 and $5,039.51.

Top 1% bill above $11,685.51.

About This Procedure

HCPCS code S5165 (Home modifications, per service) was billed by 224 providers across 401K claims, totaling $278.7M in Medicaid payments from 2018–2024. This code was used for 145K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$2,196.32

Providers Billing

209

National Spending

$278.7M

Avg/Median Ratio

1.16×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for S5165

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1699182212	$23.4M	$1,899.08	0.9× median	Below Median
2	1669715397	$19.0M	$10,242.86	4.7× median	Top 10%
3	1588977342	$17.6M	$5,406.04	2.5× median	Top 10%
4	1083941785	$17.0M	$3,775.53	1.7× median	Above 75th
5	1801030150	$15.5M	$3,879.39	1.8× median	Above 75th
6	1366821977	$14.3M	$4,113.98	1.9× median	Above 75th
7	1386045268	$9.9M	$3,601.88	1.6× median	Above Median
8	1841530375	$9.6M	$11,207.34	5.1× median	Top 10%
9	1093195075	$8.4M	$7,019.51	3.2× median	Top 10%
10	1356721658	$8.0M	$2,844.63	1.3× median	Above Median
11	Public Partnerships Llc Latham, NY · Supports Brokerage	$7.4M	$11,727.09	5.3× median	Top 1%
12	1639230030	$6.8M	$3,436.58	1.6× median	Above Median
13	1588079545	$6.4M	$1,334.15	0.6× median	Below Median
14	1891725263	$5.7M	$4,204.95	1.9× median	Above 75th
15	Massachusetts Rehabilitation Commission Worcester, MA · Community/Behavioral Health	$5.6M	$5,502.13	2.5× median	Top 10%
16	1598943177	$5.5M	$3,486.38	1.6× median	Above Median
17	1619408143	$4.3M	$3,001.25	1.4× median	Above Median
18	Girling Health Care Inc. Austin, TX · Home Health	$4.0M	$5,034.44	2.3× median	Above 75th
19	1871729616	$3.7M	$2,609.91	1.2× median	Above Median
20	1053314021	$3.2M	$89.18	0.0× median	Below Median

Showing top 20 of 224 providers billing this code

Related Procedures

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