#3164 of 11K

96121

HCPCS Procedure Code

HCPCS code 96121 is the #3,164 most-billed Medicaid procedure code, with $2.3M in payments across 45K claims from 2018–2024. The national median cost per claim is $61.42. Costs vary widely — the 90th percentile is $166.56 per claim, 2.7× the median.

Total Paid

$2.3M

0.00% of all spending

Total Claims

45K

Providers

107

Avg Cost/Claim

$52

National Cost Distribution

How much do providers bill per claim for 96121? Based on 103 providers billing this code nationally.

Median

$61.42

Average

$93.01

Std Dev

$118.60

Max

$813.41

Percentile Distribution (Cost per Claim)

p10

$8.75

p25

$39.28

Median

$61.42

p75

$111.65

p90

$166.56

p95

$268.04

p99

$598.31

50% of providers bill between $39.28 and $111.65 per claim for this code.

90% bill between $8.75 and $166.56.

Top 1% bill above $598.31.

About This Procedure

HCPCS code 96121 was billed by 107 providers across 45K claims, totaling $2.3M in Medicaid payments from 2018–2024. This code was used for 28K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$61.42

Providers Billing

103

National Spending

$2.3M

Avg/Median Ratio

1.51×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for 96121

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1881087369	$539K	$129.56	2.1× median	Above 75th
2	1134639859	$419K	$271.73	4.4× median	Top 10%
3	1821324815	$149K	$82.84	1.3× median	Above Median
4	1609360254	$136K	$8.57	0.1× median	Below Median
5	1841573375	$117K	$40.73	0.7× median	Below Median
6	1780714832	$63K	$101.72	1.7× median	Above Median
7	1679746309	$57K	$80.04	1.3× median	Above Median
8	1497780647	$54K	$128.20	2.1× median	Above 75th
9	1487155354	$49K	$53.81	0.9× median	Below Median
10	Cook Children's Medical Center Fort Worth, TX · General Acute Care Hospital Children	$45K	$312.92	5.1× median	Top 10%
11	1154689883	$45K	$206.98	3.4× median	Top 10%
12	1326115049	$44K	$165.64	2.7× median	Above 75th
13	1932569324	$40K	$45.22	0.7× median	Below Median
14	1720442965	$38K	$330.82	5.4× median	Top 10%
15	1568487130	$35K	$59.79	1.0× median	Below Median
16	1275670036	$35K	$9.46	0.2× median	Below Median
17	1891116265	$32K	$124.56	2.0× median	Above 75th
18	1083922074	$24K	$813.41	13.2× median	Top 1%
19	1275921587	$22K	$598.90	9.8× median	Top 1%
20	1316387699	$21K	$113.63	1.9× median	Above 75th

Showing top 20 of 107 providers billing this code

Related Procedures

96130Psychological testing evaluation by professional, first hour$207.4M 96127Brief emotional/behavioral assessment, per standardized instrument$191.1M 96131Psychological testing evaluation, each additional hour$126.6M 96112Developmental test administration$108.8M 96113Developmental test admin, each additional 30 min$19.7M

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