96549
HCPCS Procedure Code
HCPCS code 96549 is the #4,664 most-billed Medicaid procedure code, with $460K in payments across 8,577 claims from 2018–2024. The national median cost per claim is $4.06. Costs vary widely — the 90th percentile is $392.38 per claim, 96.6× the median.
Total Paid
$460K
0.00% of all spending
Total Claims
8,577
Providers
15
Avg Cost/Claim
$54
National Cost Distribution
How much do providers bill per claim for 96549? Based on 8 providers billing this code nationally.
Median
$4.06
Average
$144.17
Std Dev
$348.69
Max
$999.90
Percentile Distribution (Cost per Claim)
50% of providers bill between $1.98 and $40.45 per claim for this code.
90% bill between $0.73 and $392.38.
Top 1% bill above $939.15.
About This Procedure
HCPCS code 96549 was billed by 15 providers across 8,577 claims, totaling $460K in Medicaid payments from 2018–2024. This code was used for 5,152 unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$4.06
Providers Billing
8
National Spending
$460K
Avg/Median Ratio
35.51×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for 96549
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1538157508 | $330K |
| 2 | 1942473491 | $108K |
| 3 | 1407802671 | $12K |
| 4 | County Of Santa Clara San Jose, CA · Case Manager/Care Coordinator | $5K |
| 5 | 1912064585 | $4K |
| 6 | 1316027709 | $1K |
| 7 | University Of California Irvine Orange, CA · General Acute Care Hospital | $492 |
| 8 | 1316900277 | $43 |
| 9 | 1104906569 | $0 |
| 10 | University Of Utah Salt Lake City, UT · Clinic/Center, Dental | $0 |
| 11 | 1770690695 | $0 |
| 12 | Riverside Hospital Inc Newport News, VA · Psychiatric Hospital | $0 |
| 13 | Swedish Health Services Seattle, WA · General Acute Care Hospital | $0 |
| 14 | 1487904546 | $0 |
| 15 | 1598868655 | $0 |
Showing top 15 of 15 providers billing this code