#3334 of 11K

96125

HCPCS Procedure Code

HCPCS code 96125 is the #3,334 most-billed Medicaid procedure code, with $1.9M in payments across 20K claims from 2018–2024. The national median cost per claim is $58.22. Costs vary widely — the 90th percentile is $216.53 per claim, 3.7× the median.

Total Paid

$1.9M

0.00% of all spending

Total Claims

20K

Providers

Avg Cost/Claim

$93

National Cost Distribution

How much do providers bill per claim for 96125? Based on 46 providers billing this code nationally.

Median

$58.22

Average

$95.56

Std Dev

$146.15

Max

$738.22

Percentile Distribution (Cost per Claim)

p10

$5.57

p25

$19.74

Median

$58.22

p75

$78.03

p90

$216.53

p95

$403.18

p99

$656.15

50% of providers bill between $19.74 and $78.03 per claim for this code.

90% bill between $5.57 and $216.53.

Top 1% bill above $656.15.

About This Procedure

HCPCS code 96125 was billed by 56 providers across 20K claims, totaling $1.9M in Medicaid payments from 2018–2024. This code was used for 16K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$58.22

Providers Billing

National Spending

$1.9M

Avg/Median Ratio

1.64×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for 96125

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1336245828	$635K	$738.22	12.7× median	Top 1%
2	1265977714	$178K	$82.97	1.4× median	Above 75th
3	1205066016	$138K	$59.54	1.0× median	Above Median
4	1407243223	$137K	$71.07	1.2× median	Above Median
5	1629245188	$113K	$78.29	1.3× median	Above 75th
6	1932415940	$111K	$64.19	1.1× median	Above Median
7	Children's Hospital Medical Center Cincinnati, OH · Clinic/Center, Primary Care	$81K	$247.86	4.3× median	Top 10%
8	1568834216	$76K	$54.58	0.9× median	Below Median
9	1053373480	$56K	$56.43	1.0× median	Below Median
10	1376104125	$52K	$555.84	9.5× median	Top 10%
11	Ohiohealth Corporation Columbus, OH · General Acute Care Hospital	$49K	$203.29	3.5× median	Above 75th
12	1730137753	$48K	$160.38	2.8× median	Above 75th
13	1497985253	$36K	$59.39	1.0× median	Above Median
14	1104099704	$30K	$57.05	1.0× median	Below Median
15	1649425240	$29K	$77.28	1.3× median	Above Median
16	1508227109	$22K	$454.95	7.8× median	Top 10%
17	1437349370	$19K	$64.49	1.1× median	Above Median
18	1346767290	$18K	$49.73	0.9× median	Below Median
19	1992709653	$16K	$29.33	0.5× median	Below Median
20	The Metrohealth System Cleveland, OH · General Acute Care Hospital	$15K	$205.99	3.5× median	Above 75th

Showing top 20 of 56 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 96133$47.4M 96132$31.8M

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