#1645 of 11K

97602

HCPCS Procedure Code

HCPCS code 97602 is the #1,645 most-billed Medicaid procedure code, with $17.0M in payments across 255K claims from 2018–2024. The national median cost per claim is $51.00. Costs vary widely — the 90th percentile is $164.68 per claim, 3.2× the median.

Total Paid

$17.0M

0.00% of all spending

Total Claims

255K

Providers

218

Avg Cost/Claim

$67

National Cost Distribution

How much do providers bill per claim for 97602? Based on 190 providers billing this code nationally.

Median

$51.00

Average

$79.73

Std Dev

$107.48

Max

$607.78

Percentile Distribution (Cost per Claim)

p10

$6.61

p25

$22.71

Median

$51.00

p75

$90.45

p90

$164.68

p95

$269.46

p99

$580.23

50% of providers bill between $22.71 and $90.45 per claim for this code.

90% bill between $6.61 and $164.68.

Top 1% bill above $580.23.

About This Procedure

HCPCS code 97602 was billed by 218 providers across 255K claims, totaling $17.0M in Medicaid payments from 2018–2024. This code was used for 80K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$51.00

Providers Billing

190

National Spending

$17.0M

Avg/Median Ratio

1.56×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for 97602

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Best Option Healthcare Puerto Rico Llc San Juan, PR · Pharmacy Home Infusion Therapy Pharmacy	$6.3M	$87.08	1.7× median	Above Median
2	1003923434	$1.2M	$413.65	8.1× median	Top 10%
3	1710977012	$713K	$607.78	11.9× median	Top 1%
4	Niagara Falls Memorial Medical Center Niagara Falls, NY · General Acute Care Hospital	$561K	$426.48	8.4× median	Top 10%
5	1063525210	$450K	$67.20	1.3× median	Above Median
6	Lee Memorial Health System Ft Myers, FL · General Acute Care Hospital	$424K	$74.50	1.5× median	Above Median
7	Unm Hospital Albuquerque, NM · General Acute Care Hospital	$381K	$58.53	1.1× median	Above Median
8	1528062429	$337K	$53.21	1.0× median	Above Median
9	Virginia Commonwealth University Health System Authority Richmond, VA · General Acute Care Hospital	$288K	$338.85	6.6× median	Top 10%
10	Maricopa County Special Health Care District Phoenix, AZ · General Acute Care Hospital	$280K	$129.78	2.5× median	Above 75th
11	1124058615	$275K	$178.85	3.5× median	Top 10%
12	1598708513	$261K	$181.74	3.6× median	Top 10%
13	1578587150	$254K	$46.39	0.9× median	Below Median
14	The Fort Defiance Indian Hospital Board, Incorporation Fort Defiance, AZ · General Acute Care Hospital	$196K	$89.85	1.8× median	Above Median
15	1275812935	$192K	$59.50	1.2× median	Above Median
16	1265818488	$170K	$76.54	1.5× median	Above Median
17	1942288527	$169K	$164.26	3.2× median	Above 75th
18	1306897335	$165K	$93.54	1.8× median	Above 75th
19	1548393127	$161K	$14.39	0.3× median	Below Median
20	1073606901	$159K	$51.07	1.0× median	Above Median

Showing top 20 of 218 providers billing this code

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