#3074 of 11K

96167

HCPCS Procedure Code

HCPCS code 96167 is the #3,074 most-billed Medicaid procedure code, with $2.6M in payments across 64K claims from 2018–2024. The national median cost per claim is $43.84.

Total Paid

$2.6M

0.00% of all spending

Total Claims

64K

Providers

131

Avg Cost/Claim

$41

National Cost Distribution

How much do providers bill per claim for 96167? Based on 108 providers billing this code nationally.

Median

$43.84

Average

$47.25

Std Dev

$30.94

Max

$154.16

Percentile Distribution (Cost per Claim)

p10

$7.85

p25

$24.97

Median

$43.84

p75

$65.37

p90

$85.46

p95

$100.57

p99

$149.15

50% of providers bill between $24.97 and $65.37 per claim for this code.

90% bill between $7.85 and $85.46.

Top 1% bill above $149.15.

About This Procedure

HCPCS code 96167 was billed by 131 providers across 64K claims, totaling $2.6M in Medicaid payments from 2018–2024. This code was used for 49K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$43.84

Providers Billing

108

National Spending

$2.6M

Avg/Median Ratio

1.08×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 96167

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Nationwide Children's Hospital Columbus, OH · General Acute Care Hospital	$300K	$47.05	1.1× median	Above Median
2	Children's Health System Of Texas Dallas, TX · General Acute Care Hospital Children	$216K	$151.86	3.5× median	Top 1%
3	1790943066	$208K	$105.89	2.4× median	Top 10%
4	1841431509	$145K	$63.94	1.5× median	Above Median
5	1205835634	$130K	$36.44	0.8× median	Below Median
6	1215042882	$124K	$43.16	1.0× median	Below Median
7	1245312842	$124K	$55.96	1.3× median	Above Median
8	Montefiore Medical Center Bronx, NY · Anesthesiology	$76K	$53.77	1.2× median	Above Median
9	Children's Hospital Medical Center Cincinnati, OH · Clinic/Center, Primary Care	$59K	$76.49	1.7× median	Above 75th
10	1477645232	$54K	$53.52	1.2× median	Above Median
11	Phoenix Children's Hospital Phoenix, AZ · Pediatrics	$51K	$65.09	1.5× median	Above Median
12	The Nemours Foundation Wilmington, DE · Clinic/Center, Developmental Disabilities	$49K	$60.97	1.4× median	Above Median
13	Montefiore Medical Center Bronx, NY · General Acute Care Hospital	$49K	$44.67	1.0× median	Above Median
14	1821367137	$48K	$29.89	0.7× median	Below Median
15	1063454346	$46K	$69.68	1.6× median	Above 75th
16	1134670086	$44K	$90.17	2.1× median	Top 10%
17	1275079279	$42K	$66.23	1.5× median	Above 75th
18	1689800609	$40K	$67.00	1.5× median	Above 75th
19	Children's Specialty Group, Inc. Milwaukee, WI · Dentist, Pediatric Dentistry	$33K	$45.79	1.0× median	Above Median
20	1538339874	$33K	$32.76	0.7× median	Below Median

Showing top 20 of 131 providers billing this code

Related Procedures

96165Health behavior intervention, family, each additional fifteen minutes$176.7M 96159$116.2M 96158$107.5M 96164$73.4M 96160Patient-focused health risk assessment$45.1M

← All procedures Top providers →