#2193 of 11K

96111

HCPCS Procedure Code

HCPCS code 96111 is the #2,193 most-billed Medicaid procedure code, with $8.0M in payments across 106K claims from 2018–2024. The national median cost per claim is $86.72.

Total Paid

$8.0M

0.00% of all spending

Total Claims

106K

Providers

517

Avg Cost/Claim

$76

National Cost Distribution

How much do providers bill per claim for 96111? Based on 485 providers billing this code nationally.

Median

$86.72

Average

$98.41

Std Dev

$93.44

Max

$1,181.58

Percentile Distribution (Cost per Claim)

p10

$20.88

p25

$53.38

Median

$86.72

p75

$116.53

p90

$158.99

p95

$166.92

p99

$508.04

50% of providers bill between $53.38 and $116.53 per claim for this code.

90% bill between $20.88 and $158.99.

Top 1% bill above $508.04.

About This Procedure

HCPCS code 96111 was billed by 517 providers across 106K claims, totaling $8.0M in Medicaid payments from 2018–2024. This code was used for 80K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$86.72

Providers Billing

485

National Spending

$8.0M

Avg/Median Ratio

1.13×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 96111

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1700110285	$429K	$698.04	8.0× median	Top 1%
2	1942359781	$338K	$190.08	2.2× median	Top 10%
3	1922048370	$332K	$140.38	1.6× median	Above 75th
4	1356581367	$250K	$356.27	4.1× median	Top 10%
5	1962760678	$164K	$354.55	4.1× median	Top 10%
6	1568632776	$139K	$105.65	1.2× median	Above Median
7	1245211309	$127K	$111.46	1.3× median	Above Median
8	1659441327	$111K	$61.54	0.7× median	Below Median
9	1083867469	$105K	$344.95	4.0× median	Top 10%
10	1043344211	$90K	$158.41	1.8× median	Above 75th
11	1568807659	$90K	$1,181.58	13.6× median	Top 1%
12	1407957152	$81K	$96.54	1.1× median	Above Median
13	1396814331	$78K	$80.35	0.9× median	Below Median
14	1063546257	$75K	$58.33	0.7× median	Below Median
15	1023159092	$73K	$55.65	0.6× median	Below Median
16	1346464716	$72K	$104.65	1.2× median	Above Median
17	1477674158	$71K	$157.30	1.8× median	Above 75th
18	1063637411	$71K	$94.89	1.1× median	Above Median
19	1144309188	$70K	$80.96	0.9× median	Below Median
20	1801275870	$70K	$343.97	4.0× median	Top 10%

Showing top 20 of 517 providers billing this code

Related Procedures

96110Developmental screening, per standardized instrument$475.4M 96112Developmental test administration$108.8M 96101$62.6M 96113Developmental test admin, each additional 30 min$19.7M 96116Neurobehavioral status examination, first hour$17.8M

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