W0500
Waiver service, state-specific code
Waiver service, state-specific code is the #435 most-billed Medicaid procedure code, with $232.0M in payments across 476K claims from 2018–2024. The national median cost per claim is $207.17. Costs vary widely — the 90th percentile is $975.60 per claim, 4.7× the median.
Total Paid
$232.0M
0.02% of all spending
Total Claims
476K
Providers
16
Avg Cost/Claim
$487
National Cost Distribution
How much do providers bill per claim for W0500? Based on 16 providers billing this code nationally.
Median
$207.17
Average
$431.89
Std Dev
$366.48
Max
$1,045.99
Percentile Distribution (Cost per Claim)
50% of providers bill between $137.79 and $842.34 per claim for this code.
90% bill between $127.79 and $975.60.
Top 1% bill above $1,036.19.
About This Procedure
HCPCS code W0500 (Waiver service, state-specific code) was billed by 16 providers across 476K claims, totaling $232.0M in Medicaid payments from 2018–2024. This code was used for 388K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$207.17
Providers Billing
16
National Spending
$232.0M
Avg/Median Ratio
2.08×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for W0500
| # | Provider | Total Paid |
|---|---|---|
| 1 | Mercy Life Center Corporation Pittsburgh, PA · Clinic/Center Community Health | $68.4M |
| 2 | 1881620250 | $43.2M |
| 3 | 1548395585 | $30.7M |
| 4 | 1003346511 | $24.2M |
| 5 | 1164952677 | $23.6M |
| 6 | Northeast Treatment Centers Inc. Philadelphia, PA · Clinic/Center Mental Health (Including Community Mental Health Center) | $22.3M |
| 7 | 1770889594 | $7.6M |
| 8 | 1932709771 | $3.4M |
| 9 | 1275131005 | $2.8M |
| 10 | 1528198975 | $1.7M |
| 11 | 1104426352 | $1.6M |
| 12 | 1720102569 | $1.4M |
| 13 | 1215442231 | $752K |
| 14 | 1427606003 | $284K |
| 15 | 1184990608 | $70K |
| 16 | 1861054637 | $31K |
Showing top 16 of 16 providers billing this code