#1355 of 11K

90716

HCPCS Procedure Code

HCPCS code 90716 is the #1,355 most-billed Medicaid procedure code, with $25.9M in payments across 3.6M claims from 2018–2024. The national median cost per claim is $6.18. Costs vary widely — the 90th percentile is $22.65 per claim, 3.7× the median.

Total Paid

$25.9M

0.00% of all spending

Total Claims

3.6M

Providers

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for 90716? Based on 4K providers billing this code nationally.

Median

$6.18

Average

$10.81

Std Dev

$16.93

Max

$178.14

Percentile Distribution (Cost per Claim)

p10

$0.22

p25

$1.42

Median

$6.18

p75

$13.67

p90

$22.65

p95

$32.32

p99

$98.28

50% of providers bill between $1.42 and $13.67 per claim for this code.

90% bill between $0.22 and $22.65.

Top 1% bill above $98.28.

About This Procedure

HCPCS code 90716 was billed by 7K providers across 3.6M claims, totaling $25.9M in Medicaid payments from 2018–2024. This code was used for 3.4M unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$6.18

Providers Billing

National Spending

$25.9M

Avg/Median Ratio

1.75×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for 90716

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	The Arizona Partnership For Immunization Phoenix, AZ · Local Education Agency (LEA)	$955K	$53.51	8.7× median	Top 10%
2	1275550212	$832K	$63.08	10.2× median	Top 10%
3	Arkansas Department Of Health Immunizations Little Rock, AR · Public Health or Welfare	$760K	$11.11	1.8× median	Above Median
4	1194855155	$536K	$63.24	10.2× median	Top 10%
5	1376508788	$381K	$34.62	5.6× median	Top 10%
6	1669404018	$362K	$24.78	4.0× median	Top 10%
7	1578625661	$353K	$83.14	13.5× median	Top 10%
8	1356723605	$274K	$171.35	27.7× median	Top 1%
9	Saltzman Tanis Pittell Levin And Jacobson Hollywood, FL · Pediatrics	$246K	$1.98	0.3× median	Below Median
10	1487925665	$241K	$127.63	20.7× median	Top 1%
11	1689639312	$225K	$140.39	22.7× median	Top 1%
12	1568901742	$221K	$150.29	24.3× median	Top 1%
13	1639273840	$219K	$41.13	6.7× median	Top 10%
14	1538220025	$198K	$59.92	9.7× median	Top 10%
15	Mid Atlantic Pemanente Medical Group Rockville, MD · Health Maintenance Organization	$194K	$82.03	13.3× median	Top 10%
16	1003985755	$178K	$40.22	6.5× median	Top 10%
17	1922105154	$172K	$74.52	12.1× median	Top 10%
18	1528233103	$168K	$60.88	9.9× median	Top 10%
19	The Nemours Foundation Wilmington, DE · Clinic/Center, Developmental Disabilities	$164K	$13.06	2.1× median	Above Median
20	1134286248	$162K	$37.09	6.0× median	Top 10%

Showing top 20 of 7K providers billing this code

Related Procedures

90715Tdap vaccine$79.6M 90723DTaP-HepB-IPV vaccine$27.8M 90707MMR vaccine$18.7M 90710MMRV vaccine$12.4M 90713Poliovirus vaccine (IPV)$5.4M

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