T1026
Waiver services, NOS, per diem
Waiver services, NOS, per diem is the #470 most-billed Medicaid procedure code, with $202.5M in payments across 889K claims from 2018–2024. The national median cost per claim is $146.05. Costs vary widely — the 90th percentile is $383.69 per claim, 2.6× the median.
Total Paid
$202.5M
0.02% of all spending
Total Claims
889K
Providers
160
Avg Cost/Claim
$228
National Cost Distribution
How much do providers bill per claim for T1026? Based on 159 providers billing this code nationally.
Median
$146.05
Average
$206.45
Std Dev
$200.14
Max
$1,226.33
Percentile Distribution (Cost per Claim)
50% of providers bill between $98.47 and $221.74 per claim for this code.
90% bill between $72.00 and $383.69.
Top 1% bill above $1,063.89.
About This Procedure
HCPCS code T1026 (Waiver services, NOS, per diem) was billed by 160 providers across 889K claims, totaling $202.5M in Medicaid payments from 2018–2024. This code was used for 123K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$146.05
Providers Billing
159
National Spending
$202.5M
Avg/Median Ratio
1.41×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for T1026
| # | Provider | Total Paid |
|---|---|---|
| 1 | Kyppec,inc Louisville, KY · Skilled Nursing Facility, Nursing Care, Pediatric | $33.9M |
| 2 | 1417012402 | $15.6M |
| 3 | 1740214709 | $12.2M |
| 4 | 1922265586 | $10.2M |
| 5 | 1225174725 | $10.1M |
| 6 | 1245524792 | $7.7M |
| 7 | 1023551264 | $7.6M |
| 8 | 1629079272 | $6.8M |
| 9 | 1972504702 | $5.9M |
| 10 | 1497921480 | $5.8M |
| 11 | 1154341923 | $5.6M |
| 12 | Centria Healthcare Llc Farmington Hills, MI · Home Health | $5.6M |
| 13 | 1619351574 | $5.2M |
| 14 | 1386678340 | $5.2M |
| 15 | 1316945090 | $4.2M |
| 16 | 1003966748 | $4.2M |
| 17 | 1053463752 | $3.8M |
| 18 | 1720123870 | $3.4M |
| 19 | 1073914412 | $3.1M |
| 20 | 1700499746 | $3.0M |
Showing top 20 of 160 providers billing this code