#5362 of 11K

95991

HCPCS Procedure Code

HCPCS code 95991 is the #5,362 most-billed Medicaid procedure code, with $219K in payments across 4,900 claims from 2018–2024. The national median cost per claim is $30.17. Costs vary widely — the 90th percentile is $65.15 per claim, 2.2× the median.

Total Paid

$219K

0.00% of all spending

Total Claims

4,900

Providers

Avg Cost/Claim

$45

National Cost Distribution

How much do providers bill per claim for 95991? Based on 27 providers billing this code nationally.

Median

$30.17

Average

$38.99

Std Dev

$47.66

Max

$253.47

Percentile Distribution (Cost per Claim)

p10

$4.89

p25

$14.64

Median

$30.17

p75

$47.04

p90

$65.15

p95

$73.17

p99

$206.92

50% of providers bill between $14.64 and $47.04 per claim for this code.

90% bill between $4.89 and $65.15.

Top 1% bill above $206.92.

About This Procedure

HCPCS code 95991 was billed by 28 providers across 4,900 claims, totaling $219K in Medicaid payments from 2018–2024. This code was used for 4,279 unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$30.17

Providers Billing

National Spending

$219K

Avg/Median Ratio

1.29×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 95991

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1770624702	$59K	$53.05	1.8× median	Above 75th
2	University Physicians Incorporated Aurora, CO · Anesthesiology	$30K	$61.79	2.0× median	Above 75th
3	Vanderbilt University Medical Center Nashville, TN · Psychiatric Unit	$25K	$49.21	1.6× median	Above 75th
4	1093768723	$19K	$70.20	2.3× median	Top 10%
5	1629051529	$15K	$20.74	0.7× median	Below Median
6	1720282585	$14K	$253.47	8.4× median	Top 1%
7	Unm Hospital Albuquerque, NM · General Acute Care Hospital	$13K	$74.44	2.5× median	Top 10%
8	1336245828	$11K	$55.63	1.8× median	Above 75th
9	1245277631	$7K	$36.79	1.2× median	Above Median
10	1528014024	$6K	$21.63	0.7× median	Below Median
11	1184976136	$5K	$26.56	0.9× median	Below Median
12	Phoenix Children's Hospital Phoenix, AZ · Pediatrics	$4K	$33.39	1.1× median	Above Median
13	1639135643	$3K	$41.86	1.4× median	Above Median
14	1952832941	$1K	$44.87	1.5× median	Above Median
15	Vanderbilt University Medical Center Nashville, TN · Transplant Surgery	$1K	$24.96	0.8× median	Below Median
16	1689769572	$688	$38.25	1.3× median	Above Median
17	1881695146	$684	$6.39	0.2× median	Below Median
18	1699740258	$448	$37.36	1.2× median	Above Median
19	1285688788	$422	$30.17	1.0× median	Below Median
20	University Of Wisconsin Hospitals And Clinics Authority Madison, WI · General Acute Care Hospital	$291	$18.20	0.6× median	Below Median

Showing top 20 of 28 providers billing this code

Related Procedures

95990$817K 95983$599K 95992$265K 95984$191K 95999$136K

← All procedures Top providers →