T2016
Habilitation, residential, waiver; per diem
Habilitation, residential, waiver; per diem is the #3 most-billed Medicaid procedure code, with $34.90B in payments across 69.0M claims from 2018–2024. The national median cost per claim is $331.94. Costs vary widely — the 90th percentile is $3,957.36 per claim, 11.9× the median.
Total Paid
$34.90B
3.19% of all spending
Total Claims
69.0M
Providers
2K
Avg Cost/Claim
$506
National Cost Distribution
How much do providers bill per claim for T2016? Based on 2K providers billing this code nationally.
Median
$331.94
Average
$1,218.89
Std Dev
$2,119.43
Max
$15,363.35
Percentile Distribution (Cost per Claim)
50% of providers bill between $194.20 and $953.58 per claim for this code.
90% bill between $125.13 and $3,957.36.
Top 1% bill above $9,862.48.
About This Procedure
HCPCS code T2016 (Habilitation, residential, waiver; per diem) was billed by 2K providers across 69.0M claims, totaling $34.90B in Medicaid payments from 2018–2024. This code was used for 4.4M unique beneficiaries.
Investigation Context
Residential habilitation (T2016) is a per-diem code for waiver-based residential care. Typical rates range from $200–400/day. Our analysis found Massachusetts DDS agencies billing $13,000–15,000/day — 37–51x the median rate. Per diem codes cover an entire day of care, so high values may reflect bundled services.
Risk Assessment
Billing Statistics
Median Cost/Claim
$331.94
Providers Billing
2K
National Spending
$34.90B
Avg/Median Ratio
3.67×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for T2016
| # | Provider | Total Paid |
|---|---|---|
| 1 | Alabama Department Of Mental Health And Mental Retardation Montgomery, AL · Community/Behavioral Health | $1.83B |
| 2 | Department Of Developmental Services Southbridge, MA · Case Management | $1.22B |
| 3 | Commonwealth Of Massachusets Beverly, MA · Case Management | $1.03B |
| 4 | Commonwealth Of Mass-dds Hyde Park, MA · Case Management | $929.6M |
| 5 | Commonwealth Of Massachusetts-dds Hyannis, MA · Case Management | $801.1M |
| 6 | Commonwealth Of Massachusetts-dds S Weymouth, MA · Case Management | $371.4M |
| 7 | National Mentor Healthcare Phoenix, AZ · Day Training, Developmentally Disabled Services | $370.1M |
| 8 | Department Of Developmental Services Springfield, MA · Case Management | $356.3M |
| 9 | Commonwealth Of Mass-dds Walpole, MA · Case Management | $353.5M |
| 10 | Easter Seals Midwest Ballwin, MO · Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | $344.5M |
| 11 | Commonwealth Of Massachusetts Haverhill, MA · Case Management | $333.1M |
| 12 | Consumer Directed Services In Texas Inc. San Antonio, TX · Supports Brokerage | $305.7M |
| 13 | Commonwealth Of Mass-dds Framingham, MA · Case Management | $292.2M |
| 14 | Commonwealth Of Massachusetts Arlington, MA · Case Management | $289.8M |
| 15 | The Tungland Company, Llc Phoenix, AZ · Residential Treatment Facility, Intellectual and/or Developmental Disabilities | $288.3M |
| 16 | Granite Bay Care Inc Portland, ME · Residential Treatment Facility Intellectual and/or Developmental Disabilities | $280.5M |
| 17 | Department Of Developmental Services Fitchburg, MA · Case Management | $277.0M |
| 18 | Commonwealth Of Massachusetts-dds Taunton, MA · Case Management | $276.7M |
| 19 | Commonwealth Of Massachusetts-dds Plymouth, MA · Case Management | $257.9M |
| 20 | Commonwealth Of Massachusetts-dds Brockton, MA · Case Management | $254.8M |
Showing top 20 of 2K providers billing this code