#1995 of 11K

97016

HCPCS Procedure Code

HCPCS code 97016 is the #1,995 most-billed Medicaid procedure code, with $10.4M in payments across 824K claims from 2018–2024. The national median cost per claim is $8.30. Costs vary widely — the 90th percentile is $28.95 per claim, 3.5× the median.

Total Paid

$10.4M

0.00% of all spending

Total Claims

824K

Providers

497

Avg Cost/Claim

$13

National Cost Distribution

How much do providers bill per claim for 97016? Based on 452 providers billing this code nationally.

Median

$8.30

Average

$13.41

Std Dev

$17.37

Max

$202.73

Percentile Distribution (Cost per Claim)

p10

$2.24

p25

$5.67

Median

$8.30

p75

$15.87

p90

$28.95

p95

$36.40

p99

$91.46

50% of providers bill between $5.67 and $15.87 per claim for this code.

90% bill between $2.24 and $28.95.

Top 1% bill above $91.46.

About This Procedure

HCPCS code 97016 was billed by 497 providers across 824K claims, totaling $10.4M in Medicaid payments from 2018–2024. This code was used for 235K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$8.30

Providers Billing

452

National Spending

$10.4M

Avg/Median Ratio

1.62×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for 97016

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	District Hospital Partners L P Washington, DC · Nurse Practitioner, Family	$906K	$114.78	13.8× median	Top 1%
2	1528061827	$326K	$14.53	1.8× median	Above Median
3	1528628633	$322K	$13.05	1.6× median	Above Median
4	Virginia Commonwealth University Health System Authority Richmond, VA · General Acute Care Hospital	$312K	$37.16	4.5× median	Top 10%
5	1891407235	$253K	$16.04	1.9× median	Above 75th
6	Ohio State University Hospitals Columbus, OH · General Acute Care Hospital	$228K	$43.34	5.2× median	Top 10%
7	1164851085	$200K	$9.62	1.2× median	Above Median
8	1306557491	$198K	$16.07	1.9× median	Above 75th
9	1760193858	$190K	$16.47	2.0× median	Above 75th
10	1528848934	$189K	$16.30	2.0× median	Above 75th
11	1528569316	$188K	$5.05	0.6× median	Below Median
12	1417646860	$165K	$15.76	1.9× median	Above Median
13	Mercy Health - St Vincent Medical Center Llc Toledo, OH · Ambulance, Land Transport	$164K	$30.31	3.7× median	Top 10%
14	1518017144	$161K	$42.29	5.1× median	Top 10%
15	1962276980	$154K	$16.44	2.0× median	Above 75th
16	1477332880	$153K	$16.15	1.9× median	Above 75th
17	1538304050	$149K	$23.97	2.9× median	Above 75th
18	University Of Kentucky Lexington, KY · General Acute Care Hospital	$145K	$26.47	3.2× median	Above 75th
19	1790493401	$144K	$15.93	1.9× median	Above 75th
20	1295419638	$132K	$16.48	2.0× median	Above 75th

Showing top 20 of 497 providers billing this code

Related Procedures

97014Electrical stimulation, unattended$82.1M 97010Hot/cold packs application$67.9M 97012Mechanical traction therapy$24.8M 97026$2.8M 97018Paraffin bath therapy$1.8M

← All procedures Top providers →