#4935 of 11K

96120

HCPCS Procedure Code

HCPCS code 96120 is the #4,935 most-billed Medicaid procedure code, with $348K in payments across 15K claims from 2018–2024. The national median cost per claim is $19.72. Costs vary widely — the 90th percentile is $68.27 per claim, 3.5× the median.

Total Paid

$348K

0.00% of all spending

Total Claims

15K

Providers

Avg Cost/Claim

$23

National Cost Distribution

How much do providers bill per claim for 96120? Based on 80 providers billing this code nationally.

Median

$19.72

Average

$28.78

Std Dev

$35.26

Max

$217.23

Percentile Distribution (Cost per Claim)

p10

$1.50

p25

$5.01

Median

$19.72

p75

$34.49

p90

$68.27

p95

$88.83

p99

$176.64

50% of providers bill between $5.01 and $34.49 per claim for this code.

90% bill between $1.50 and $68.27.

Top 1% bill above $176.64.

About This Procedure

HCPCS code 96120 was billed by 92 providers across 15K claims, totaling $348K in Medicaid payments from 2018–2024. This code was used for 13K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$19.72

Providers Billing

National Spending

$348K

Avg/Median Ratio

1.46×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 96120

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1619403870	$68K	$34.36	1.7× median	Above Median
2	1942749387	$26K	$165.85	8.4× median	Top 10%
3	1427108323	$20K	$97.99	5.0× median	Top 10%
4	1861689093	$19K	$35.10	1.8× median	Above 75th
5	1366806655	$15K	$15.57	0.8× median	Below Median
6	1437565900	$15K	$19.01	1.0× median	Below Median
7	1407112329	$15K	$55.91	2.8× median	Above 75th
8	1184938201	$13K	$18.51	0.9× median	Below Median
9	1376967422	$11K	$45.60	2.3× median	Above 75th
10	1528263647	$11K	$21.73	1.1× median	Above Median
11	1619100377	$10K	$38.27	1.9× median	Above 75th
12	1275641888	$9K	$27.29	1.4× median	Above Median
13	1629018981	$9K	$13.76	0.7× median	Below Median
14	1508100876	$9K	$70.34	3.6× median	Top 10%
15	1831454685	$9K	$34.14	1.7× median	Above Median
16	University Of Wisconsin Hospitals And Clinics Authority Madison, WI · General Acute Care Hospital	$8K	$91.40	4.6× median	Top 10%
17	1053358846	$7K	$68.11	3.5× median	Above 75th
18	1104240324	$6K	$26.60	1.3× median	Above Median
19	1174717185	$6K	$34.87	1.8× median	Above 75th
20	1972782670	$5K	$19.02	1.0× median	Below Median

Showing top 20 of 92 providers billing this code

Related Procedures

96110Developmental screening, per standardized instrument$475.4M 96130Psychological testing evaluation by professional, first hour$207.4M 96127Brief emotional/behavioral assessment, per standardized instrument$191.1M 96112Developmental test administration$108.8M 96113Developmental test admin, each additional 30 min$19.7M

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