96401
HCPCS Procedure Code
HCPCS code 96401 is the #1,426 most-billed Medicaid procedure code, with $23.6M in payments across 403K claims from 2018–2024. The national median cost per claim is $40.24. Costs vary widely — the 90th percentile is $110.34 per claim, 2.7× the median.
Total Paid
$23.6M
0.00% of all spending
Total Claims
403K
Providers
478
Avg Cost/Claim
$59
National Cost Distribution
How much do providers bill per claim for 96401? Based on 466 providers billing this code nationally.
Median
$40.24
Average
$72.42
Std Dev
$303.60
Max
$6,274.70
Percentile Distribution (Cost per Claim)
50% of providers bill between $19.71 and $68.36 per claim for this code.
90% bill between $6.63 and $110.34.
Top 1% bill above $403.61.
About This Procedure
HCPCS code 96401 was billed by 478 providers across 403K claims, totaling $23.6M in Medicaid payments from 2018–2024. This code was used for 235K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$40.24
Providers Billing
466
National Spending
$23.6M
Avg/Median Ratio
1.80×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for 96401
| # | Provider | Total Paid |
|---|---|---|
| 1 | Spartanburg Medical Center Spartanburg, SC · Ambulance | $1.5M |
| 2 | Dana-farber Cancer Institute, Inc. Boston, MA · General Acute Care Hospital | $1.5M |
| 3 | 1821285974 | $1.5M |
| 4 | Hmh Hospitals Corporation Hackensack, NJ · Ambulance | $1.1M |
| 5 | 1346288255 | $974K |
| 6 | 1033132857 | $704K |
| 7 | Boston Medical Center Corporation Boston, MA · General Acute Care Hospital | $541K |
| 8 | Medical University Hospital Authority Charleston, SC · General Acute Care Hospital | $429K |
| 9 | 1023175239 | $401K |
| 10 | 1134102080 | $389K |
| 11 | 1699756221 | $386K |
| 12 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $373K |
| 13 | 1174822902 | $369K |
| 14 | 1245217751 | $342K |
| 15 | The General Hospital Corporation Boston, MA · General Acute Care Hospital | $319K |
| 16 | 1104188424 | $309K |
| 17 | 1942382874 | $258K |
| 18 | 1568772523 | $253K |
| 19 | 1265462659 | $239K |
| 20 | 1780667923 | $231K |
Showing top 20 of 478 providers billing this code