99199
Unlisted special service, procedure, or report
Unlisted special service, procedure, or report is the #87 most-billed Medicaid procedure code, with $2.24B in payments across 173.3M claims from 2018–2024. The national median cost per claim is $5.39. Costs vary widely — the 90th percentile is $50.94 per claim, 9.5× the median.
Total Paid
$2.24B
0.21% of all spending
Total Claims
173.3M
Providers
4K
Avg Cost/Claim
$13
National Cost Distribution
How much do providers bill per claim for 99199? Based on 4K providers billing this code nationally.
Median
$5.39
Average
$47.78
Std Dev
$402.17
Max
$10,635.51
Percentile Distribution (Cost per Claim)
50% of providers bill between $3.83 and $6.74 per claim for this code.
90% bill between $2.98 and $50.94.
Top 1% bill above $392.27.
About This Procedure
HCPCS code 99199 (Unlisted special service, procedure, or report) was billed by 4K providers across 173.3M claims, totaling $2.24B in Medicaid payments from 2018–2024. This code was used for 120.0M unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$5.39
Providers Billing
4K
National Spending
$2.24B
Avg/Median Ratio
8.86×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for 99199
| # | Provider | Total Paid |
|---|---|---|
| 1 | Howard Center Inc Burlington, VT · Day Training Developmentally Disabled Services | $224.8M |
| 2 | Northeast Kingdom Human Services Inc Ds Waiver Newport, VT · Clinic/Center Developmental Disabilities | $144.1M |
| 3 | Washington County Mental Health Services Inc. Barre, VT · Clinic/Center Developmental Disabilities | $101.7M |
| 4 | Health Care & Rehabilitation Services Bellows Falls, VT · Clinic/Center Developmental Disabilities | $97.6M |
| 5 | Northwestern Counseling & Support Services Saint Albans, VT · Community/Behavioral Health | $90.9M |
| 6 | Rutland Mental Health Services Rutland, VT · Clinic/Center Developmental Disabilities | $83.1M |
| 7 | United Counseling Service Of Bennington County Inc. Bennington, VT · Clinic/Center Developmental Disabilities | $50.3M |
| 8 | 1598729014 | $45.6M |
| 9 | Counseling Service Of Addison County Middlebury, VT · Clinic/Center Developmental Disabilities | $45.3M |
| 10 | 1275651267 | $40.5M |
| 11 | 1144347824 | $33.6M |
| 12 | County Of Milwaukee Milwaukee, WI · Community/Behavioral Health | $31.3M |
| 13 | Green Mountain Support Services Inc. Morrisville, VT · Case Manager/Care Coordinator | $25.9M |
| 14 | Wake Forest University Health Sciences Winston Salem, NC · Clinic/Center, Multi-Specialty | $23.8M |
| 15 | Dane County Department Of Human Services Madison, WI · Community/Behavioral Health | $21.2M |
| 16 | 1972645422 | $20.3M |
| 17 | Western Region Recovery & Wellness Consortia Chippewa Falls, WI · Community/Behavioral Health | $17.9M |
| 18 | Transition Ii Burlington, VT · Case Manager/Care Coordinator | $17.3M |
| 19 | 1528209681 | $13.7M |
| 20 | 1801957576 | $13.6M |
Showing top 20 of 4K providers billing this code