#5610 of 11K

97605

HCPCS Procedure Code

HCPCS code 97605 is the #5,610 most-billed Medicaid procedure code, with $168K in payments across 3,865 claims from 2018–2024. The national median cost per claim is $31.60. Costs vary widely — the 90th percentile is $123.56 per claim, 3.9× the median.

Total Paid

$168K

0.00% of all spending

Total Claims

3,865

Providers

Avg Cost/Claim

$43

National Cost Distribution

How much do providers bill per claim for 97605? Based on 24 providers billing this code nationally.

Median

$31.60

Average

$54.84

Std Dev

$56.42

Max

$205.73

Percentile Distribution (Cost per Claim)

p10

$8.62

p25

$13.47

Median

$31.60

p75

$87.47

p90

$123.56

p95

$166.49

p99

$198.39

50% of providers bill between $13.47 and $87.47 per claim for this code.

90% bill between $8.62 and $123.56.

Top 1% bill above $198.39.

About This Procedure

HCPCS code 97605 was billed by 26 providers across 3,865 claims, totaling $168K in Medicaid payments from 2018–2024. This code was used for 1,262 unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$31.60

Providers Billing

National Spending

$168K

Avg/Median Ratio

1.74×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for 97605

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1063457380	$38K	$125.04	4.0× median	Top 10%
2	1952309098	$38K	$98.95	3.1× median	Above 75th
3	1518912609	$16K	$120.12	3.8× median	Above 75th
4	1447299649	$11K	$7.59	0.2× median	Below Median
5	Yuma Regional Medical Center Yuma, AZ · General Acute Care Hospital	$11K	$30.16	1.0× median	Below Median
6	1942288527	$11K	$205.73	6.5× median	Top 1%
7	1295772093	$8K	$102.65	3.2× median	Above 75th
8	Texas Children's Hospital Houston, TX · General Acute Care Hospital Children	$8K	$173.80	5.5× median	Top 10%
9	Aurora Health Care Metro, Inc. Milwaukee, WI · Internal Medicine, Hematology & Oncology	$6K	$55.40	1.8× median	Above Median
10	1114908001	$5K	$69.60	2.2× median	Above Median
11	1578058137	$4K	$83.65	2.6× median	Above Median
12	Providence Health & Services Washington Anchorage, AK · General Acute Care Hospital	$3K	$41.97	1.3× median	Above Median
13	Hmh Hospitals Corporation Edison, NJ · General Acute Care Hospital	$3K	$41.70	1.3× median	Above Median
14	1144286402	$2K	$14.94	0.5× median	Below Median
15	1548393127	$2K	$11.04	0.3× median	Below Median
16	1225085855	$713	$18.28	0.6× median	Below Median
17	1114964244	$694	$33.04	1.0× median	Above Median
18	1124098421	$552	$11.26	0.4× median	Below Median
19	1508942525	$522	$14.12	0.4× median	Below Median
20	1841241437	$400	$22.24	0.7× median	Below Median

Showing top 20 of 26 providers billing this code

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