#1615 of 11K

94799

HCPCS Procedure Code

HCPCS code 94799 is the #1,615 most-billed Medicaid procedure code, with $17.7M in payments across 203K claims from 2018–2024. The national median cost per claim is $8.65. Costs vary widely — the 90th percentile is $89.06 per claim, 10.3× the median.

Total Paid

$17.7M

0.00% of all spending

Total Claims

203K

Providers

169

Avg Cost/Claim

$87

National Cost Distribution

How much do providers bill per claim for 94799? Based on 141 providers billing this code nationally.

Median

$8.65

Average

$111.62

Std Dev

$423.44

Max

$3,086.36

Percentile Distribution (Cost per Claim)

p10

$0.30

p25

$1.84

Median

$8.65

p75

$46.81

p90

$89.06

p95

$256.43

p99

$2,412.02

50% of providers bill between $1.84 and $46.81 per claim for this code.

90% bill between $0.30 and $89.06.

Top 1% bill above $2,412.02.

About This Procedure

HCPCS code 94799 was billed by 169 providers across 203K claims, totaling $17.7M in Medicaid payments from 2018–2024. This code was used for 125K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$8.65

Providers Billing

141

National Spending

$17.7M

Avg/Median Ratio

12.90×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for 94799

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1407064470	$4.1M	$85.11	9.8× median	Above 75th
2	1316045537	$2.3M	$853.27	98.6× median	Top 10%
3	1851386957	$2.2M	$1,724.07	199.3× median	Top 10%
4	1407271430	$2.1M	$3,086.36	356.8× median	Top 1%
5	1972972867	$1.8M	$86.32	10.0× median	Above 75th
6	1669419271	$1.6M	$1,022.30	118.2× median	Top 10%
7	1851348460	$1.3M	$2,726.19	315.2× median	Top 1%
8	1588953996	$212K	$84.27	9.7× median	Above 75th
9	1083952857	$209K	$74.94	8.7× median	Above 75th
10	1811493364	$188K	$1,046.81	121.0× median	Top 10%
11	Kennedy University Hospital Inc. Stratford, NJ · General Acute Care Hospital	$176K	$77.16	8.9× median	Above 75th
12	1013981554	$161K	$83.80	9.7× median	Above 75th
13	The Nemours Foundation Wilmington, DE · General Acute Care Hospital Children	$147K	$60.86	7.0× median	Above 75th
14	1821147786	$99K	$80.24	9.3× median	Above 75th
15	1083002141	$89K	$1,940.77	224.4× median	Top 10%
16	Children's Hospital & Research Center At Oakland Oakland, CA · General Acute Care Hospital	$88K	$136.13	15.7× median	Top 10%
17	1568879864	$76K	$50.66	5.9× median	Above 75th
18	1992703540	$71K	$90.43	10.5× median	Top 10%
19	Grossmont Hospital Corporation La Mesa, CA · General Acute Care Hospital	$62K	$26.11	3.0× median	Above Median
20	Sharp Chula Vista Medical Center Chula Vista, CA · General Acute Care Hospital	$55K	$33.43	3.9× median	Above Median

Showing top 20 of 169 providers billing this code

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