97155
Adaptive behavior treatment with protocol modification, per 15 minutes
Adaptive behavior treatment with protocol modification, per 15 minutes is the #132 most-billed Medicaid procedure code, with $1.44B in payments across 9.4M claims from 2018–2024. The national median cost per claim is $146.45.
Total Paid
$1.44B
0.13% of all spending
Total Claims
9.4M
Providers
3K
Avg Cost/Claim
$153
National Cost Distribution
How much do providers bill per claim for 97155? Based on 3K providers billing this code nationally.
Median
$146.45
Average
$158.51
Std Dev
$99.29
Max
$2,633.36
Percentile Distribution (Cost per Claim)
50% of providers bill between $110.29 and $189.46 per claim for this code.
90% bill between $73.49 and $242.40.
Top 1% bill above $435.68.
About This Procedure
HCPCS code 97155 (Adaptive behavior treatment with protocol modification, per 15 minutes) was billed by 3K providers across 9.4M claims, totaling $1.44B in Medicaid payments from 2018–2024. This code was used for 2.0M unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$146.45
Providers Billing
3K
National Spending
$1.44B
Avg/Median Ratio
1.08×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 97155
| # | Provider | Total Paid |
|---|---|---|
| 1 | Centria Healthcare Llc Farmington Hills, MI · Home Health | $76.3M |
| 2 | Abs Utah P.c. Salt Lake City, UT · Community/Behavioral Health | $30.0M |
| 3 | Gateway Pediatric Therapy Llc Bingham Farms, MI · Behavior Analyst | $26.0M |
| 4 | Behavior Interventions, Inc King Of Prussia, PA · Behavior Analyst | $19.1M |
| 5 | Eric Lund Green Bay, WI · Psychologist Clinical | $17.1M |
| 6 | Vav Operations Llc South Bend, IN · Community/Behavioral Health | $16.6M |
| 7 | Comprehab Llc Gastonia, NC · Speech-Language Pathologist, | $15.6M |
| 8 | Brett Dinovi & Associates Pa Llc Bensalem, PA · Behavior Analyst | $13.9M |
| 9 | 1558841163 | $13.5M |
| 10 | 1144682873 | $13.3M |
| 11 | 1760977649 | $12.5M |
| 12 | 1285992743 | $12.3M |
| 13 | 1609135748 | $12.1M |
| 14 | 1255706628 | $11.9M |
| 15 | 1649506940 | $11.0M |
| 16 | 1194212282 | $10.8M |
| 17 | 1962765693 | $10.5M |
| 18 | 1366047474 | $9.2M |
| 19 | Easter Seals Southern California Inc Irvine, CA · Behavior Analyst | $9.1M |
| 20 | 1609194000 | $8.5M |
Showing top 20 of 3K providers billing this code