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#245 of 11K

T2019

Habilitation, prevocational, waiver; per 15 min

Habilitation, prevocational, waiver; per 15 min is the #245 most-billed Medicaid procedure code, with $588.2M in payments across 5.3M claims from 2018–2024. The national median cost per claim is $88.91. Costs vary widely — the 90th percentile is $428.53 per claim, 4.8× the median.

Total Paid

$588.2M

0.05% of all spending

Total Claims

5.3M

Providers

607

Avg Cost/Claim

$112

National Cost Distribution

How much do providers bill per claim for T2019? Based on 600 providers billing this code nationally.

Median

$88.91

Average

$180.74

Std Dev

$279.61

Max

$2,559.43

Percentile Distribution (Cost per Claim)

p10
$32.96
p25
$53.33
Median
$88.91
p75
$170.93
p90
$428.53
p95
$646.40
p99
$1,380.92

50% of providers bill between $53.33 and $170.93 per claim for this code.

90% bill between $32.96 and $428.53.

Top 1% bill above $1,380.92.

About This Procedure

HCPCS code T2019 (Habilitation, prevocational, waiver; per 15 min) was billed by 607 providers across 5.3M claims, totaling $588.2M in Medicaid payments from 2018–2024. This code was used for 688K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$88.91

Providers Billing

600

National Spending

$588.2M

Avg/Median Ratio

2.03×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for T2019

#ProviderTotal Paid
11851762223$25.1M
2Guardiantrac. Llc

Sturgis, MI · Community/Behavioral Health

$23.2M
31649577453$17.6M
4Department Of Intellectual And Developmental Disabilities, State Of Tn

Nashville, TN · Public Health or Welfare

$16.8M
5Marc Community Resources, Inc

Mesa, AZ · Preferred Provider Organization

$12.3M
61235738824$10.3M
71518315613$9.8M
81184109308$9.4M
91982053518$9.0M
101558410688$8.6M
111437289097$7.8M
12Commonwealth Of Massachusetts-dds

New Bedford, MA · Case Management

$7.4M
13Bancroft A New Jersey Nonprofit Corporation

Cherry Hill, NJ · Clinic/Center Rehabilitation

$6.8M
14Department Of Developmental Services

Holyoke, MA · Case Management

$6.3M
15Alabama Department Of Mental Health And Mental Retardation

Montgomery, AL · Community/Behavioral Health

$6.1M
161508154790$5.8M
17Easter Seals Blake Foundation

Tucson, AZ · Case Management

$5.7M
181558868653$5.7M
19The Tungland Company, Llc

Phoenix, AZ · Residential Treatment Facility, Intellectual and/or Developmental Disabilities

$5.6M
201215051388$5.6M

Showing top 20 of 607 providers billing this code