96365
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour is the #164 most-billed Medicaid procedure code, with $1.07B in payments across 12.8M claims from 2018–2024. The national median cost per claim is $54.77. Costs vary widely — the 90th percentile is $143.42 per claim, 2.6× the median.
Total Paid
$1.07B
0.10% of all spending
Total Claims
12.8M
Providers
4K
Avg Cost/Claim
$83
National Cost Distribution
How much do providers bill per claim for 96365? Based on 4K providers billing this code nationally.
Median
$54.77
Average
$71.09
Std Dev
$67.85
Max
$1,134.29
Percentile Distribution (Cost per Claim)
50% of providers bill between $27.91 and $96.70 per claim for this code.
90% bill between $12.73 and $143.42.
Top 1% bill above $274.07.
About This Procedure
HCPCS code 96365 (IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour) was billed by 4K providers across 12.8M claims, totaling $1.07B in Medicaid payments from 2018–2024. This code was used for 9.0M unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$54.77
Providers Billing
4K
National Spending
$1.07B
Avg/Median Ratio
1.30×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 96365
| # | Provider | Total Paid |
|---|---|---|
| 1 | The General Hospital Corporation Boston, MA · General Acute Care Hospital | $10.9M |
| 2 | Yale New Haven Hospital New Haven, CT · General Acute Care Hospital | $7.7M |
| 3 | Newyork-presbyterian-queens Flushing, NY · General Acute Care Hospital | $7.0M |
| 4 | Brigham & Womens Hospital Inc. Boston, MA · General Acute Care Hospital | $6.9M |
| 5 | Virginia Commonwealth University Health System Authority Richmond, VA · General Acute Care Hospital | $6.2M |
| 6 | The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital | $5.5M |
| 7 | University Of Kentucky Lexington, KY · General Acute Care Hospital | $5.4M |
| 8 | Suny Health Science Center At Syracuse Syracuse, NY · General Acute Care Hospital | $5.2M |
| 9 | Baystate Medical Center Inc Springfield, MA · General Acute Care Hospital | $5.2M |
| 10 | Hmh Hospitals Corporation Hackensack, NJ · Ambulance | $4.7M |
| 11 | Henry Ford Health System Detroit, MI · General Acute Care Hospital | $4.6M |
| 12 | 1881915031 | $4.5M |
| 13 | Rector & Visitors Of The University Of Virginia Charlottesville, VA · General Acute Care Hospital | $4.5M |
| 14 | Rhode Island Hospital Providence, RI · General Acute Care Hospital | $4.4M |
| 15 | Umass Memorial Medical Center, Inc. Worcester, MA · General Acute Care Hospital | $4.3M |
| 16 | 1477549756 | $4.2M |
| 17 | Carolinas Medical Center Charlotte, NC · General Acute Care Hospital | $4.2M |
| 18 | The New York And Presbyterian Hospital New York, NY · General Acute Care Hospital | $4.1M |
| 19 | Englewood Hospital And Medical Center Englewood, NJ · General Acute Care Hospital | $4.0M |
| 20 | Tufts Medical Center, Inc. Boston, MA · General Acute Care Hospital | $3.9M |
Showing top 20 of 4K providers billing this code