97537
HCPCS Procedure Code
HCPCS code 97537 is the #943 most-billed Medicaid procedure code, with $56.1M in payments across 2.2M claims from 2018–2024. The national median cost per claim is $24.64. Costs vary widely — the 90th percentile is $104.71 per claim, 4.2× the median.
Total Paid
$56.1M
0.01% of all spending
Total Claims
2.2M
Providers
99
Avg Cost/Claim
$26
National Cost Distribution
How much do providers bill per claim for 97537? Based on 90 providers billing this code nationally.
Median
$24.64
Average
$45.42
Std Dev
$53.07
Max
$285.00
Percentile Distribution (Cost per Claim)
50% of providers bill between $20.02 and $43.11 per claim for this code.
90% bill between $10.89 and $104.71.
Top 1% bill above $229.32.
About This Procedure
HCPCS code 97537 was billed by 99 providers across 2.2M claims, totaling $56.1M in Medicaid payments from 2018–2024. This code was used for 152K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$24.64
Providers Billing
90
National Spending
$56.1M
Avg/Median Ratio
1.84×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for 97537
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1295879542 | $6.7M |
| 2 | 1265556435 | $6.6M |
| 3 | Rise Inc Boise, ID · Voluntary or Charitable | $3.7M |
| 4 | 1447373147 | $3.7M |
| 5 | 1841414604 | $2.1M |
| 6 | 1245440692 | $1.7M |
| 7 | 1346234267 | $1.6M |
| 8 | Progressive Behavior Systems Pa Rupert, ID · Day Training Developmentally Disabled Services | $1.6M |
| 9 | 1295850493 | $1.6M |
| 10 | 1679617955 | $1.6M |
| 11 | 1255473203 | $1.5M |
| 12 | 1851415129 | $1.5M |
| 13 | 1104948322 | $1.5M |
| 14 | 1972724623 | $1.5M |
| 15 | 1760523062 | $1.2M |
| 16 | 1487869939 | $1.1M |
| 17 | 1154589802 | $1.1M |
| 18 | 1316061054 | $1.0M |
| 19 | 1871123901 | $863K |
| 20 | 1104048503 | $841K |
Showing top 20 of 99 providers billing this code