96040
HCPCS Procedure Code
HCPCS code 96040 is the #2,296 most-billed Medicaid procedure code, with $7.0M in payments across 152K claims from 2018–2024. The national median cost per claim is $32.05. Costs vary widely — the 90th percentile is $79.92 per claim, 2.5× the median.
Total Paid
$7.0M
0.00% of all spending
Total Claims
152K
Providers
248
Avg Cost/Claim
$46
National Cost Distribution
How much do providers bill per claim for 96040? Based on 216 providers billing this code nationally.
Median
$32.05
Average
$38.81
Std Dev
$38.80
Max
$302.71
Percentile Distribution (Cost per Claim)
50% of providers bill between $13.80 and $44.75 per claim for this code.
90% bill between $2.99 and $79.92.
Top 1% bill above $190.31.
About This Procedure
HCPCS code 96040 was billed by 248 providers across 152K claims, totaling $7.0M in Medicaid payments from 2018–2024. This code was used for 140K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$32.05
Providers Billing
216
National Spending
$7.0M
Avg/Median Ratio
1.21×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 96040
| # | Provider | Total Paid |
|---|---|---|
| 1 | Children's Hospital Of Wisconsin, Inc. Milwaukee, WI · Dentist, Pediatric Dentistry | $1.0M |
| 2 | Rector & Visitors Of The University Of Virginia Charlottesville, VA · General Acute Care Hospital | $796K |
| 3 | Children's Hospital Washington, DC · General Acute Care Hospital Children | $570K |
| 4 | 1114920048 | $376K |
| 5 | University Of Wisconsin Hospitals And Clinics Authority Madison, WI · General Acute Care Hospital | $348K |
| 6 | Women & Infants Hospital Of Rhode Island Providence, RI · Clinic/Center, Ambulatory Family Planning Facility | $293K |
| 7 | 1871770289 | $179K |
| 8 | Medstar Washington Hospital Center Washington, DC · General Acute Care Hospital | $175K |
| 9 | 1376593442 | $171K |
| 10 | 1801869250 | $124K |
| 11 | Upmc Children's Hospital Of Pittsburgh Pittsburgh, PA · Clinic/Center | $104K |
| 12 | 1194099390 | $103K |
| 13 | New York City Health And Hospitals Corporation Bronx, NY · Internal Medicine | $98K |
| 14 | 1013924372 | $90K |
| 15 | 1508266347 | $89K |
| 16 | 1336245828 | $88K |
| 17 | Suny Health Science Center At Syracuse Syracuse, NY · General Acute Care Hospital | $85K |
| 18 | 1043269798 | $81K |
| 19 | Children's Hospital Medical Center Cincinnati, OH · Clinic/Center, Primary Care | $74K |
| 20 | 1134306541 | $73K |
Showing top 20 of 248 providers billing this code