#2738 of 11K

95938

HCPCS Procedure Code

HCPCS code 95938 is the #2,738 most-billed Medicaid procedure code, with $3.9M in payments across 120K claims from 2018–2024. The national median cost per claim is $26.58. Costs vary widely — the 90th percentile is $147.24 per claim, 5.5× the median.

Total Paid

$3.9M

0.00% of all spending

Total Claims

120K

Providers

123

Avg Cost/Claim

$32

National Cost Distribution

How much do providers bill per claim for 95938? Based on 118 providers billing this code nationally.

Median

$26.58

Average

$50.22

Std Dev

$64.29

Max

$324.52

Percentile Distribution (Cost per Claim)

p10

$13.69

p25

$18.10

Median

$26.58

p75

$41.30

p90

$147.24

p95

$210.24

p99

$294.56

50% of providers bill between $18.10 and $41.30 per claim for this code.

90% bill between $13.69 and $147.24.

Top 1% bill above $294.56.

About This Procedure

HCPCS code 95938 was billed by 123 providers across 120K claims, totaling $3.9M in Medicaid payments from 2018–2024. This code was used for 109K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$26.58

Providers Billing

118

National Spending

$3.9M

Avg/Median Ratio

1.89×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for 95938

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1740391283	$795K	$28.47	1.1× median	Above Median
2	1124253075	$503K	$19.05	0.7× median	Below Median
3	1285630129	$459K	$154.59	5.8× median	Top 10%
4	1578631727	$422K	$170.20	6.4× median	Top 10%
5	1134307531	$139K	$20.57	0.8× median	Below Median
6	1659640381	$97K	$23.28	0.9× median	Below Median
7	1790083723	$82K	$24.25	0.9× median	Below Median
8	1194925206	$74K	$21.84	0.8× median	Below Median
9	1598066730	$67K	$26.91	1.0× median	Above Median
10	1174916522	$63K	$13.61	0.5× median	Below Median
11	New York Network Ipa Inc Brooklyn, NY · Exclusive Provider Organization	$59K	$149.92	5.6× median	Top 10%
12	1659765204	$55K	$143.51	5.4× median	Above 75th
13	1396937454	$52K	$42.23	1.6× median	Above 75th
14	1750487096	$48K	$30.11	1.1× median	Above Median
15	1780066373	$47K	$78.57	3.0× median	Above 75th
16	1437278157	$46K	$218.00	8.2× median	Top 10%
17	1336492800	$46K	$19.69	0.7× median	Below Median
18	1326098005	$42K	$38.41	1.4× median	Above Median
19	1508231267	$42K	$10.00	0.4× median	Below Median
20	1649372673	$39K	$31.14	1.2× median	Above Median

Showing top 20 of 123 providers billing this code

Related Procedures

95941$14.9M 95930Visual evoked potential testing$5.0M 95939$2.3M 95943$1.6M 95937$504K

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