#4751 of 11K

96168

HCPCS Procedure Code

HCPCS code 96168 is the #4,751 most-billed Medicaid procedure code, with $420K in payments across 12K claims from 2018–2024. The national median cost per claim is $25.73. Costs vary widely — the 90th percentile is $89.11 per claim, 3.5× the median.

Total Paid

$420K

0.00% of all spending

Total Claims

12K

Providers

Avg Cost/Claim

$35

National Cost Distribution

How much do providers bill per claim for 96168? Based on 35 providers billing this code nationally.

Median

$25.73

Average

$36.36

Std Dev

$31.80

Max

$127.70

Percentile Distribution (Cost per Claim)

p10

$5.00

p25

$16.49

Median

$25.73

p75

$46.36

p90

$89.11

p95

$100.10

p99

$119.84

50% of providers bill between $16.49 and $46.36 per claim for this code.

90% bill between $5.00 and $89.11.

Top 1% bill above $119.84.

About This Procedure

HCPCS code 96168 was billed by 39 providers across 12K claims, totaling $420K in Medicaid payments from 2018–2024. This code was used for 8,209 unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$25.73

Providers Billing

National Spending

$420K

Avg/Median Ratio

1.41×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 96168

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1790943066	$186K	$104.59	4.1× median	Top 10%
2	1336716901	$50K	$98.18	3.8× median	Top 10%
3	1245312842	$38K	$24.53	1.0× median	Below Median
4	Children's Health System Of Texas Dallas, TX · General Acute Care Hospital Children	$24K	$127.70	5.0× median	Top 1%
5	1821367137	$17K	$19.44	0.8× median	Below Median
6	1932286101	$16K	$79.30	3.1× median	Above 75th
7	1689892473	$12K	$52.64	2.0× median	Above 75th
8	1063454346	$8K	$47.03	1.8× median	Above 75th
9	1063502946	$8K	$36.49	1.4× median	Above Median
10	1891909867	$7K	$70.75	2.7× median	Above 75th
11	1952781411	$7K	$25.73	1.0× median	Below Median
12	New York City Health And Hospitals Corporation Jamaica, NY · General Acute Care Hospital	$6K	$34.44	1.3× median	Above Median
13	Phoenix Children's Hospital Phoenix, AZ · Pediatrics	$6K	$37.83	1.5× median	Above Median
14	1194140616	$5K	$35.40	1.4× median	Above Median
15	1730334426	$5K	$95.65	3.7× median	Top 10%
16	1710959457	$4K	$32.65	1.3× median	Above Median
17	Children's Specialty Group, Inc. Milwaukee, WI · Dentist, Pediatric Dentistry	$4K	$20.09	0.8× median	Below Median
18	1841573375	$2K	$23.69	0.9× median	Below Median
19	1699720086	$2K	$19.50	0.8× median	Below Median
20	Community Physicians Of Indiana Inc Indianapolis, IN · Internal Medicine	$2K	$15.51	0.6× median	Below Median

Showing top 20 of 39 providers billing this code

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