#2421 of 11K

S5190

Wellness assessment, performed by non-physician

Wellness assessment, performed by non-physician is the #2,421 most-billed Medicaid procedure code, with $5.9M in payments across 189K claims from 2018–2024. The national median cost per claim is $33.67. Costs vary widely — the 90th percentile is $161.67 per claim, 4.8× the median.

Total Paid

$5.9M

0.00% of all spending

Total Claims

189K

Providers

249

Avg Cost/Claim

$31

National Cost Distribution

How much do providers bill per claim for S5190? Based on 164 providers billing this code nationally.

Median

$33.67

Average

$63.88

Std Dev

$89.78

Max

$551.00

Percentile Distribution (Cost per Claim)

p10

$0.12

p25

$17.88

Median

$33.67

p75

$78.11

p90

$161.67

p95

$253.21

p99

$411.60

50% of providers bill between $17.88 and $78.11 per claim for this code.

90% bill between $0.12 and $161.67.

Top 1% bill above $411.60.

About This Procedure

HCPCS code S5190 (Wellness assessment, performed by non-physician) was billed by 249 providers across 189K claims, totaling $5.9M in Medicaid payments from 2018–2024. This code was used for 160K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$33.67

Providers Billing

164

National Spending

$5.9M

Avg/Median Ratio

1.90×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for S5190

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1366872970	$648K	$334.76	9.9× median	Top 10%
2	1578743878	$523K	$459.90	13.7× median	Top 1%
3	1861528648	$330K	$19.29	0.6× median	Below Median
4	1508528878	$298K	$190.04	5.6× median	Top 10%
5	1073062949	$260K	$349.08	10.4× median	Top 10%
6	1881813152	$226K	$246.84	7.3× median	Top 10%
7	1841334711	$204K	$20.31	0.6× median	Below Median
8	1306855762	$196K	$152.34	4.5× median	Above 75th
9	County Of Outagamie Appleton, WI · Clinic/Center Mental Health (Including Community Mental Health Center)	$181K	$201.28	6.0× median	Top 10%
10	1467190082	$174K	$163.57	4.9× median	Top 10%
11	1750425625	$152K	$17.82	0.5× median	Below Median
12	1669516530	$150K	$19.34	0.6× median	Below Median
13	1114095395	$130K	$279.38	8.3× median	Top 10%
14	1548216484	$110K	$31.91	0.9× median	Below Median
15	1144681099	$95K	$17.30	0.5× median	Below Median
16	1659415529	$94K	$17.91	0.5× median	Below Median
17	1194060053	$90K	$147.87	4.4× median	Above 75th
18	1285778993	$86K	$20.83	0.6× median	Below Median
19	1710032909	$84K	$41.51	1.2× median	Above Median
20	1184747594	$81K	$157.23	4.7× median	Above 75th

Showing top 20 of 249 providers billing this code

Related Procedures

S5199Personal care item, NOS, each$52.6M S5185Medication reminder service, NOS, per month$15.6M S5181Home health training, per visit$1.8M S5180Home health respiratory therapy, per visit$1.3M

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