98961
HCPCS Procedure Code
HCPCS code 98961 is the #4,573 most-billed Medicaid procedure code, with $509K in payments across 97K claims from 2018–2024. The national median cost per claim is $16.35. Costs vary widely — the 90th percentile is $33.90 per claim, 2.1× the median.
Total Paid
$509K
0.00% of all spending
Total Claims
97K
Providers
36
Avg Cost/Claim
$5
National Cost Distribution
How much do providers bill per claim for 98961? Based on 24 providers billing this code nationally.
Median
$16.35
Average
$49.66
Std Dev
$120.96
Max
$494.09
Percentile Distribution (Cost per Claim)
50% of providers bill between $7.86 and $21.18 per claim for this code.
90% bill between $0.66 and $33.90.
Top 1% bill above $467.95.
About This Procedure
HCPCS code 98961 was billed by 36 providers across 97K claims, totaling $509K in Medicaid payments from 2018–2024. This code was used for 78K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$16.35
Providers Billing
24
National Spending
$509K
Avg/Median Ratio
3.04×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for 98961
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1689225351 | $187K |
| 2 | 1487191201 | $110K |
| 3 | 1063030419 | $86K |
| 4 | 1588322515 | $43K |
| 5 | 1942999255 | $23K |
| 6 | 1376612820 | $22K |
| 7 | 1134838352 | $18K |
| 8 | 1235649260 | $5K |
| 9 | 1942596275 | $3K |
| 10 | 1902956006 | $2K |
| 11 | 1124097621 | $2K |
| 12 | 1538889738 | $2K |
| 13 | 1225682347 | $1K |
| 14 | 1952302689 | $1K |
| 15 | 1710432919 | $1K |
| 16 | 1679911531 | $583 |
| 17 | Children's Hospital Of Wisconsin, Inc. Milwaukee, WI · Dentist, Pediatric Dentistry | $351 |
| 18 | 1174066278 | $308 |
| 19 | 1619677762 | $300 |
| 20 | 1669530986 | $294 |
Showing top 20 of 36 providers billing this code