96416
HCPCS Procedure Code
HCPCS code 96416 is the #1,422 most-billed Medicaid procedure code, with $23.7M in payments across 145K claims from 2018–2024. The national median cost per claim is $118.51. Costs vary widely — the 90th percentile is $298.14 per claim, 2.5× the median.
Total Paid
$23.7M
0.00% of all spending
Total Claims
145K
Providers
184
Avg Cost/Claim
$164
National Cost Distribution
How much do providers bill per claim for 96416? Based on 180 providers billing this code nationally.
Median
$118.51
Average
$149.63
Std Dev
$122.74
Max
$769.92
Percentile Distribution (Cost per Claim)
50% of providers bill between $63.27 and $206.95 per claim for this code.
90% bill between $29.62 and $298.14.
Top 1% bill above $601.61.
About This Procedure
HCPCS code 96416 was billed by 184 providers across 145K claims, totaling $23.7M in Medicaid payments from 2018–2024. This code was used for 81K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$118.51
Providers Billing
180
National Spending
$23.7M
Avg/Median Ratio
1.26×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 96416
| # | Provider | Total Paid |
|---|---|---|
| 1 | Memorial Hospital For Cancer And Allied Diseases New York, NY · Pharmacy | $3.7M |
| 2 | Yale New Haven Hospital New Haven, CT · General Acute Care Hospital | $1.3M |
| 3 | Dana-farber Cancer Institute, Inc. Boston, MA · General Acute Care Hospital | $987K |
| 4 | The New York And Presbyterian Hospital New York, NY · General Acute Care Hospital | $929K |
| 5 | The Cooper Health System Camden, NJ · General Acute Care Hospital | $848K |
| 6 | Long Island Jewish Medical Center New Hyde Park, NY · General Acute Care Hospital | $718K |
| 7 | Arthur G James Cancer Hospital And Research Institute Columbus, OH · Special Hospital | $626K |
| 8 | Swedish Health Services Seattle, WA · General Acute Care Hospital | $549K |
| 9 | Rhode Island Hospital Providence, RI · General Acute Care Hospital | $505K |
| 10 | Beth Israel Deaconess Medical Center, Inc. Boston, MA · General Acute Care Hospital | $492K |
| 11 | Inova Health Care Services Falls Church, VA · Clinic/Center, Rehabilitation, Substance Use Disorder | $427K |
| 12 | Boston Medical Center Corporation Boston, MA · General Acute Care Hospital | $399K |
| 13 | Unm Hospital Albuquerque, NM · General Acute Care Hospital | $398K |
| 14 | 1437230034 | $363K |
| 15 | Multicare Health System Tacoma, WA · Community/Behavioral Health | $353K |
| 16 | 1770690695 | $350K |
| 17 | The General Hospital Corporation Boston, MA · General Acute Care Hospital | $341K |
| 18 | City Of Hope National Medical Center Duarte, CA · General Acute Care Hospital | $326K |
| 19 | University Hospitals Cleveland Medical Center Cleveland, OH · General Acute Care Hospital | $298K |
| 20 | Virginia Commonwealth University Health System Authority Richmond, VA · General Acute Care Hospital | $291K |
Showing top 20 of 184 providers billing this code