96159
HCPCS Procedure Code
HCPCS code 96159 is the #645 most-billed Medicaid procedure code, with $116.2M in payments across 1.0M claims from 2018–2024. The national median cost per claim is $20.68. Costs vary widely — the 90th percentile is $131.66 per claim, 6.4× the median.
Total Paid
$116.2M
0.01% of all spending
Total Claims
1.0M
Providers
428
Avg Cost/Claim
$113
National Cost Distribution
How much do providers bill per claim for 96159? Based on 391 providers billing this code nationally.
Median
$20.68
Average
$44.95
Std Dev
$56.88
Max
$302.55
Percentile Distribution (Cost per Claim)
50% of providers bill between $14.10 and $37.80 per claim for this code.
90% bill between $7.91 and $131.66.
Top 1% bill above $284.81.
About This Procedure
HCPCS code 96159 was billed by 428 providers across 1.0M claims, totaling $116.2M in Medicaid payments from 2018–2024. This code was used for 266K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$20.68
Providers Billing
391
National Spending
$116.2M
Avg/Median Ratio
2.17×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for 96159
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1154482982 | $8.4M |
| 2 | 1043366099 | $7.4M |
| 3 | 1932260841 | $7.3M |
| 4 | The Board Of Education Of The City Of Chicago Chicago, IL · Local Education Agency (LEA) | $5.1M |
| 5 | 1346343217 | $4.7M |
| 6 | 1770755878 | $4.1M |
| 7 | 1942351572 | $3.7M |
| 8 | 1215094354 | $3.5M |
| 9 | 1629342746 | $3.4M |
| 10 | 1063459881 | $3.3M |
| 11 | Baltimore City Schools Baltimore, MD · Local Education Agency (LEA) | $3.1M |
| 12 | 1215090196 | $2.9M |
| 13 | 1366540619 | $2.9M |
| 14 | 1376695320 | $2.8M |
| 15 | 1265587042 | $2.7M |
| 16 | 1437759107 | $2.2M |
| 17 | 1184167652 | $2.1M |
| 18 | 1598812448 | $1.9M |
| 19 | 1750428991 | $1.8M |
| 20 | 1700325685 | $1.7M |
Showing top 20 of 428 providers billing this code