96409
HCPCS Procedure Code
HCPCS code 96409 is the #1,598 most-billed Medicaid procedure code, with $18.0M in payments across 200K claims from 2018–2024. The national median cost per claim is $72.14. Costs vary widely — the 90th percentile is $188.12 per claim, 2.6× the median.
Total Paid
$18.0M
0.00% of all spending
Total Claims
200K
Providers
186
Avg Cost/Claim
$90
National Cost Distribution
How much do providers bill per claim for 96409? Based on 179 providers billing this code nationally.
Median
$72.14
Average
$88.45
Std Dev
$87.06
Max
$517.02
Percentile Distribution (Cost per Claim)
50% of providers bill between $25.87 and $117.58 per claim for this code.
90% bill between $8.76 and $188.12.
Top 1% bill above $446.28.
About This Procedure
HCPCS code 96409 was billed by 186 providers across 200K claims, totaling $18.0M in Medicaid payments from 2018–2024. This code was used for 119K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$72.14
Providers Billing
179
National Spending
$18.0M
Avg/Median Ratio
1.23×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 96409
| # | Provider | Total Paid |
|---|---|---|
| 1 | Hmh Hospitals Corporation Hackensack, NJ · Ambulance | $1.6M |
| 2 | Scottish Rite Children's Medical Center Atlanta, GA · Pediatrics Pediatric Hematology-Oncology | $1.5M |
| 3 | Dana-farber Cancer Institute, Inc. Boston, MA · General Acute Care Hospital | $1.2M |
| 4 | Yale New Haven Hospital New Haven, CT · General Acute Care Hospital | $943K |
| 5 | Phoenix Children's Hospital Phoenix, AZ · General Acute Care Hospital Children | $865K |
| 6 | Newark Beth Israel Medical Center Inc Newark, NJ · General Acute Care Hospital | $779K |
| 7 | Egleston Children's Hospital At Emory University Inc. Atlanta, GA · Pediatrics Pediatric Emergency Medicine | $642K |
| 8 | Boston Medical Center Corporation Boston, MA · General Acute Care Hospital | $531K |
| 9 | Robert Wood Johnson University Hospital, Inc New Brunswick, NJ · General Acute Care Hospital | $522K |
| 10 | Banner - University Medical Center Tucson Campus Llc Tucson, AZ · Clinic/Center, Multi-Specialty | $445K |
| 11 | Vhs Childrens Hospital Of Michigan Inc Detroit, MI · Clinic/Center, Ambulatory Surgical | $392K |
| 12 | Virginia Commonwealth University Health System Authority Richmond, VA · General Acute Care Hospital | $378K |
| 13 | Long Island Jewish Medical Center New Hyde Park, NY · General Acute Care Hospital | $374K |
| 14 | Connecticut Children's Medical Center Hartford, CT · General Acute Care Hospital, Children | $348K |
| 15 | Regents Of The University Of Michigan Ann Arbor, MI · Clinic/Center, End-Stage Renal Disease (ESRD) Treatment | $308K |
| 16 | 1548315401 | $303K |
| 17 | Spectrum Health Hospitals Grand Rapids, MI · General Acute Care Hospital | $287K |
| 18 | Memorial Hospital For Cancer And Allied Diseases New York, NY · Pharmacy | $250K |
| 19 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $245K |
| 20 | University Of Kentucky Lexington, KY · General Acute Care Hospital | $218K |
Showing top 20 of 186 providers billing this code