#1247 of 11K

97811

HCPCS Procedure Code

HCPCS code 97811 is the #1,247 most-billed Medicaid procedure code, with $31.3M in payments across 1.7M claims from 2018–2024. The national median cost per claim is $19.71. Costs vary widely — the 90th percentile is $45.81 per claim, 2.3× the median.

Total Paid

$31.3M

0.00% of all spending

Total Claims

1.7M

Providers

857

Avg Cost/Claim

$19

National Cost Distribution

How much do providers bill per claim for 97811? Based on 709 providers billing this code nationally.

Median

$19.71

Average

$23.11

Std Dev

$19.46

Max

$250.30

Percentile Distribution (Cost per Claim)

p10

$2.39

p25

$11.06

Median

$19.71

p75

$30.96

p90

$45.81

p95

$53.30

p99

$79.80

50% of providers bill between $11.06 and $30.96 per claim for this code.

90% bill between $2.39 and $45.81.

Top 1% bill above $79.80.

About This Procedure

HCPCS code 97811 was billed by 857 providers across 1.7M claims, totaling $31.3M in Medicaid payments from 2018–2024. This code was used for 748K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$19.71

Providers Billing

709

National Spending

$31.3M

Avg/Median Ratio

1.17×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 97811

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1871637249	$1.3M	$55.19	2.8× median	Top 10%
2	1881773869	$686K	$28.10	1.4× median	Above Median
3	1922352095	$574K	$30.55	1.5× median	Above Median
4	1497141766	$521K	$109.65	5.6× median	Top 1%
5	1437216025	$512K	$50.05	2.5× median	Top 10%
6	1427449024	$499K	$45.62	2.3× median	Above 75th
7	Hennepin Healthcare System Inc Minneapolis, MN · General Acute Care Hospital	$485K	$24.20	1.2× median	Above Median
8	1194135723	$468K	$47.14	2.4× median	Top 10%
9	1861525602	$455K	$24.72	1.3× median	Above Median
10	1760970255	$436K	$43.38	2.2× median	Above 75th
11	1598106692	$385K	$27.03	1.4× median	Above Median
12	1427494566	$376K	$40.67	2.1× median	Above 75th
13	1063081073	$341K	$56.06	2.8× median	Top 10%
14	1396178067	$338K	$25.68	1.3× median	Above Median
15	1982092276	$334K	$33.80	1.7× median	Above 75th
16	1073635231	$326K	$24.86	1.3× median	Above Median
17	1245432954	$322K	$42.75	2.2× median	Above 75th
18	1740422062	$319K	$35.66	1.8× median	Above 75th
19	The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital	$313K	$13.66	0.7× median	Below Median
20	1780866889	$302K	$69.57	3.5× median	Top 10%

Showing top 20 of 857 providers billing this code

Related Procedures

97803Medical nutrition therapy, reassessment, group, thirty minutes$151.3M 97802Medical nutrition therapy, reassessment, individual, fifteen minutes$107.6M 97810$56.1M 97813$17.6M 97814$15.5M

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