97158
HCPCS Procedure Code
HCPCS code 97158 is the #2,144 most-billed Medicaid procedure code, with $8.5M in payments across 67K claims from 2018–2024. The national median cost per claim is $56.17. Costs vary widely — the 90th percentile is $220.54 per claim, 3.9× the median.
Total Paid
$8.5M
0.00% of all spending
Total Claims
67K
Providers
55
Avg Cost/Claim
$127
National Cost Distribution
How much do providers bill per claim for 97158? Based on 54 providers billing this code nationally.
Median
$56.17
Average
$95.97
Std Dev
$97.90
Max
$407.68
Percentile Distribution (Cost per Claim)
50% of providers bill between $24.45 and $133.45 per claim for this code.
90% bill between $15.98 and $220.54.
Top 1% bill above $394.44.
About This Procedure
HCPCS code 97158 was billed by 55 providers across 67K claims, totaling $8.5M in Medicaid payments from 2018–2024. This code was used for 12K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$56.17
Providers Billing
54
National Spending
$8.5M
Avg/Median Ratio
1.71×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for 97158
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1215548615 | $3.1M |
| 2 | 1417229774 | $1.4M |
| 3 | 1942780473 | $1.2M |
| 4 | 1427642032 | $481K |
| 5 | 1265858864 | $309K |
| 6 | 1134352792 | $253K |
| 7 | 1417364787 | $233K |
| 8 | 1518448331 | $184K |
| 9 | 1760977649 | $183K |
| 10 | 1770624991 | $166K |
| 11 | 1225287758 | $138K |
| 12 | 1316619745 | $109K |
| 13 | Residential Options Inc. Lansing, MI · Behavior Analyst | $107K |
| 14 | Nationwide Children's Hospital Columbus, OH · General Acute Care Hospital | $72K |
| 15 | 1275037046 | $70K |
| 16 | 1578222147 | $62K |
| 17 | 1386101327 | $49K |
| 18 | 1710291786 | $45K |
| 19 | 1316020910 | $44K |
| 20 | 1497177398 | $42K |
Showing top 20 of 55 providers billing this code