97130
HCPCS Procedure Code
HCPCS code 97130 is the #840 most-billed Medicaid procedure code, with $68.7M in payments across 1.8M claims from 2018–2024. The national median cost per claim is $21.60. Costs vary widely — the 90th percentile is $82.14 per claim, 3.8× the median.
Total Paid
$68.7M
0.01% of all spending
Total Claims
1.8M
Providers
251
Avg Cost/Claim
$38
National Cost Distribution
How much do providers bill per claim for 97130? Based on 220 providers billing this code nationally.
Median
$21.60
Average
$37.92
Std Dev
$41.39
Max
$223.28
Percentile Distribution (Cost per Claim)
50% of providers bill between $9.39 and $62.73 per claim for this code.
90% bill between $1.45 and $82.14.
Top 1% bill above $207.23.
About This Procedure
HCPCS code 97130 was billed by 251 providers across 1.8M claims, totaling $68.7M in Medicaid payments from 2018–2024. This code was used for 360K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$21.60
Providers Billing
220
National Spending
$68.7M
Avg/Median Ratio
1.76×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for 97130
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1912166075 | $15.8M |
| 2 | Bilinguals Inc. Forest Hills, NY · Early Intervention Provider Agency | $8.5M |
| 3 | 1740596568 | $5.7M |
| 4 | 1679617955 | $5.6M |
| 5 | 1033426739 | $3.5M |
| 6 | 1629409867 | $3.2M |
| 7 | 1629002936 | $2.0M |
| 8 | Universal Rehabilitation And Fitness, Inc. Livingston, NJ · Clinic/Center, Rehabilitation | $1.6M |
| 9 | 1871123901 | $1.4M |
| 10 | Goodwill Industries Of Northern New England Portland, ME · Clinic/Center Rehabilitation Comprehensive Outpatient Rehabilitation Facility (CORF) | $1.3M |
| 11 | 1639585342 | $1.1M |
| 12 | 1831441054 | $1.1M |
| 13 | 1023236445 | $1.0M |
| 14 | 1619113255 | $1.0M |
| 15 | 1508928995 | $937K |
| 16 | Bancroft A New Jersey Nonprofit Corporation Cherry Hill, NJ · Clinic/Center Rehabilitation | $823K |
| 17 | 1912131368 | $730K |
| 18 | 1669513404 | $702K |
| 19 | 1114262318 | $639K |
| 20 | 1700208709 | $635K |
Showing top 20 of 251 providers billing this code