#1621 of 11K

97813

HCPCS Procedure Code

HCPCS code 97813 is the #1,621 most-billed Medicaid procedure code, with $17.6M in payments across 854K claims from 2018–2024. The national median cost per claim is $26.35.

Total Paid

$17.6M

0.00% of all spending

Total Claims

854K

Providers

514

Avg Cost/Claim

$21

National Cost Distribution

How much do providers bill per claim for 97813? Based on 457 providers billing this code nationally.

Median

$26.35

Average

$28.65

Std Dev

$49.28

Max

$719.00

Percentile Distribution (Cost per Claim)

p10

$3.59

p25

$14.00

Median

$26.35

p75

$34.90

p90

$40.37

p95

$48.01

p99

$108.20

50% of providers bill between $14.00 and $34.90 per claim for this code.

90% bill between $3.59 and $40.37.

Top 1% bill above $108.20.

About This Procedure

HCPCS code 97813 was billed by 514 providers across 854K claims, totaling $17.6M in Medicaid payments from 2018–2024. This code was used for 334K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$26.35

Providers Billing

457

National Spending

$17.6M

Avg/Median Ratio

1.09×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 97813

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1073264636	$1.0M	$113.37	4.3× median	Top 1%
2	1578902524	$762K	$18.81	0.7× median	Below Median
3	1134491848	$742K	$16.60	0.6× median	Below Median
4	1598848970	$595K	$74.86	2.8× median	Top 10%
5	1609990936	$593K	$34.72	1.3× median	Above Median
6	1174940258	$405K	$35.35	1.3× median	Above 75th
7	1578721338	$331K	$27.22	1.0× median	Above Median
8	1760970255	$295K	$53.46	2.0× median	Top 10%
9	1922532167	$280K	$33.62	1.3× median	Above Median
10	1821117623	$278K	$15.84	0.6× median	Below Median
11	1508309089	$275K	$29.03	1.1× median	Above Median
12	1821442104	$262K	$27.54	1.0× median	Above Median
13	1083971204	$218K	$27.73	1.1× median	Above Median
14	1174093215	$212K	$22.39	0.8× median	Below Median
15	1023322427	$205K	$25.73	1.0× median	Below Median
16	1750548137	$202K	$36.62	1.4× median	Above 75th
17	1659634293	$197K	$25.58	1.0× median	Below Median
18	1942626866	$191K	$22.29	0.8× median	Below Median
19	1467944884	$189K	$24.49	0.9× median	Below Median
20	1982793733	$187K	$28.93	1.1× median	Above Median

Showing top 20 of 514 providers billing this code

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97803Medical nutrition therapy, reassessment, group, thirty minutes$151.3M 97810$56.1M 97811$31.3M 97814$15.5M 97804$3.8M

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