97154
Group adaptive behavior treatment, per 15 min
Group adaptive behavior treatment, per 15 min is the #750 most-billed Medicaid procedure code, with $89.0M in payments across 969K claims from 2018–2024. The national median cost per claim is $55.95. Costs vary widely — the 90th percentile is $155.78 per claim, 2.8× the median.
Total Paid
$89.0M
0.01% of all spending
Total Claims
969K
Providers
174
Avg Cost/Claim
$92
National Cost Distribution
How much do providers bill per claim for 97154? Based on 170 providers billing this code nationally.
Median
$55.95
Average
$77.03
Std Dev
$71.31
Max
$346.62
Percentile Distribution (Cost per Claim)
50% of providers bill between $21.34 and $108.86 per claim for this code.
90% bill between $11.04 and $155.78.
Top 1% bill above $322.33.
About This Procedure
HCPCS code 97154 (Group adaptive behavior treatment, per 15 min) was billed by 174 providers across 969K claims, totaling $89.0M in Medicaid payments from 2018–2024. This code was used for 103K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$55.95
Providers Billing
170
National Spending
$89.0M
Avg/Median Ratio
1.38×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 97154
| # | Provider | Total Paid |
|---|---|---|
| 1 | Step By Step Inc. Wilkes Barre, PA · Voluntary or Charitable | $27.9M |
| 2 | 1609938513 | $19.0M |
| 3 | 1063743037 | $4.9M |
| 4 | Easter Seals Southern California Inc Irvine, CA · Behavior Analyst | $4.1M |
| 5 | National Mentor Healthcare, Llc Broomall, PA · Community/Behavioral Health | $3.3M |
| 6 | 1437290129 | $2.6M |
| 7 | 1164557716 | $1.6M |
| 8 | Fraser Child And Family Center Minneapolis, MN · Clinic/Center, Mental Health (Including Community Mental Health Center) | $1.6M |
| 9 | 1689776718 | $1.5M |
| 10 | 1124163910 | $1.4M |
| 11 | 1508081639 | $1.3M |
| 12 | 1467598730 | $1.3M |
| 13 | 1760977649 | $1.2M |
| 14 | 1508100447 | $981K |
| 15 | 1376000208 | $849K |
| 16 | Autism Opportunities Foundation Minnetonka, MN · Psychologist | $708K |
| 17 | 1235209065 | $655K |
| 18 | 1609194000 | $652K |
| 19 | 1942780473 | $614K |
| 20 | 1497760086 | $572K |
Showing top 20 of 174 providers billing this code