#968 of 11K

S5199

Personal care item, NOS, each

Personal care item, NOS, each is the #968 most-billed Medicaid procedure code, with $52.6M in payments across 2.3M claims from 2018–2024. The national median cost per claim is $10.82. Costs vary widely — the 90th percentile is $88.31 per claim, 8.2× the median.

Total Paid

$52.6M

0.00% of all spending

Total Claims

2.3M

Providers

217

Avg Cost/Claim

$23

National Cost Distribution

How much do providers bill per claim for S5199? Based on 202 providers billing this code nationally.

Median

$10.82

Average

$45.54

Std Dev

$170.52

Max

$2,333.17

Percentile Distribution (Cost per Claim)

p10

$1.04

p25

$3.16

Median

$10.82

p75

$55.33

p90

$88.31

p95

$141.52

p99

$217.30

50% of providers bill between $3.16 and $55.33 per claim for this code.

90% bill between $1.04 and $88.31.

Top 1% bill above $217.30.

About This Procedure

HCPCS code S5199 (Personal care item, NOS, each) was billed by 217 providers across 2.3M claims, totaling $52.6M in Medicaid payments from 2018–2024. This code was used for 2.2M unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$10.82

Providers Billing

202

National Spending

$52.6M

Avg/Median Ratio

4.21×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for S5199

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Medline Industries, Lp Grayslake, IL · Durable Medical Equipment & Medical Supplies	$18.9M	$108.99	10.1× median	Top 10%
2	1427228634	$7.5M	$70.66	6.5× median	Above 75th
3	J&b Medical Supply Co Inc Wixom, MI · Durable Medical Equipment & Medical Supplies	$3.0M	$7.12	0.7× median	Below Median
4	1982653523	$2.1M	$60.53	5.6× median	Above 75th
5	1962791020	$2.1M	$80.31	7.4× median	Above 75th
6	1992975700	$1.8M	$61.92	5.7× median	Above 75th
7	J & B Medical Supply Co Inc Wixom, MI · Durable Medical Equipment & Medical Supplies	$1.7M	$2.17	0.2× median	Below Median
8	1457310849	$1.3M	$519.46	48.0× median	Top 1%
9	1174839617	$1.1M	$57.43	5.3× median	Above 75th
10	1497837280	$1.0M	$11.09	1.0× median	Above Median
11	1871559641	$788K	$100.10	9.3× median	Top 10%
12	Aeroflow Inc Arden, NC · Durable Medical Equipment & Medical Supplies	$739K	$9.20	0.9× median	Below Median
13	1316123870	$647K	$66.22	6.1× median	Above 75th
14	1023146115	$614K	$106.84	9.9× median	Top 10%
15	1629213418	$613K	$21.45	2.0× median	Above Median
16	1710083308	$574K	$48.62	4.5× median	Above Median
17	1417267634	$534K	$31.73	2.9× median	Above Median
18	1568465185	$416K	$14.19	1.3× median	Above Median
19	1790863066	$384K	$55.02	5.1× median	Above Median
20	1235175605	$381K	$61.49	5.7× median	Above 75th

Showing top 20 of 217 providers billing this code

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