#3604 of 11K

96921

HCPCS Procedure Code

HCPCS code 96921 is the #3,604 most-billed Medicaid procedure code, with $1.4M in payments across 12K claims from 2018–2024. The national median cost per claim is $106.73. Costs vary widely — the 90th percentile is $220.91 per claim, 2.1× the median.

Total Paid

$1.4M

0.00% of all spending

Total Claims

12K

Providers

Avg Cost/Claim

$119

National Cost Distribution

How much do providers bill per claim for 96921? Based on 24 providers billing this code nationally.

Median

$106.73

Average

$127.77

Std Dev

$68.74

Max

$325.31

Percentile Distribution (Cost per Claim)

p10

$70.67

p25

$94.22

Median

$106.73

p75

$148.72

p90

$220.91

p95

$247.28

p99

$308.11

50% of providers bill between $94.22 and $148.72 per claim for this code.

90% bill between $70.67 and $220.91.

Top 1% bill above $308.11.

About This Procedure

HCPCS code 96921 was billed by 24 providers across 12K claims, totaling $1.4M in Medicaid payments from 2018–2024. This code was used for 5,414 unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$106.73

Providers Billing

National Spending

$1.4M

Avg/Median Ratio

1.20×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 96921

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1134201460	$438K	$152.86	1.4× median	Above 75th
2	1629219522	$187K	$103.81	1.0× median	Below Median
3	1164656229	$182K	$202.54	1.9× median	Above 75th
4	1013917665	$154K	$165.15	1.5× median	Above 75th
5	1124014741	$85K	$95.93	0.9× median	Below Median
6	1194002733	$85K	$88.32	0.8× median	Below Median
7	1417263922	$50K	$108.08	1.0× median	Above Median
8	1285746552	$38K	$78.25	0.7× median	Below Median
9	1184027104	$34K	$46.54	0.4× median	Below Median
10	1063782621	$32K	$105.38	1.0× median	Below Median
11	1225309586	$29K	$147.34	1.4× median	Above Median
12	1013994839	$27K	$117.17	1.1× median	Above Median
13	1558812875	$26K	$228.78	2.1× median	Top 10%
14	1396741351	$12K	$89.10	0.8× median	Below Median
15	1184777427	$10K	$136.02	1.3× median	Above Median
16	1447220215	$10K	$250.54	2.3× median	Top 10%
17	1609826163	$9K	$136.69	1.3× median	Above Median
18	1033457395	$8K	$101.99	1.0× median	Below Median
19	1487659512	$6K	$96.54	0.9× median	Below Median
20	1821285974	$6K	$67.43	0.6× median	Below Median

Showing top 20 of 24 providers billing this code

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