99205
Office/outpatient visit, new patient, high complexity
Office/outpatient visit, new patient, high complexity is the #284 most-billed Medicaid procedure code, with $498.9M in payments across 3.7M claims from 2018–2024. The national median cost per claim is $111.09.
Total Paid
$498.9M
0.05% of all spending
Total Claims
3.7M
Providers
11K
Avg Cost/Claim
$136
National Cost Distribution
How much do providers bill per claim for 99205? Based on 11K providers billing this code nationally.
Median
$111.09
Average
$126.43
Std Dev
$120.49
Max
$2,516.06
Percentile Distribution (Cost per Claim)
50% of providers bill between $80.32 and $153.66 per claim for this code.
90% bill between $46.24 and $203.39.
Top 1% bill above $349.56.
About This Procedure
HCPCS code 99205 (Office/outpatient visit, new patient, high complexity) was billed by 11K providers across 3.7M claims, totaling $498.9M in Medicaid payments from 2018–2024. This code was used for 3.4M unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$111.09
Providers Billing
11K
National Spending
$498.9M
Avg/Median Ratio
1.14×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 99205
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1689031528 | $18.6M |
| 2 | Los Angeles County Department Of Mental Health Los Angeles, CA · Clinic/Center, Mental Health (Including Community Mental Health Center) | $5.3M |
| 3 | Children's Specialized Hospital New Brunswick, NJ · Pediatrics | $4.8M |
| 4 | 1215995402 | $4.5M |
| 5 | County Of Riverside Riverside, CA · Community/Behavioral Health | $4.3M |
| 6 | Boston Medical Center Corporation Boston, MA · General Acute Care Hospital | $3.9M |
| 7 | 1265813125 | $3.6M |
| 8 | 1548507080 | $2.7M |
| 9 | William Beaumont Hospital Royal Oak, MI · Internal Medicine, Cardiovascular Disease | $2.6M |
| 10 | Spectrum Health Primary Care Partners Grand Rapids, MI · Psychologist, Clinical Child & Adolescent | $2.5M |
| 11 | 1306867585 | $2.4M |
| 12 | North Shore-lij Medical Pc Great Neck, NY · Urology | $2.2M |
| 13 | Ideal Option, Pllc Pasco, WA · Preventive Medicine, Addiction Medicine | $2.1M |
| 14 | Park Nicollet Clinic St Louis Park, MN · Obstetrics & Gynecology | $2.0M |
| 15 | The Nemours Foundation Wilmington, DE · Clinic/Center, Developmental Disabilities | $1.9M |
| 16 | Montefiore Medical Center Bronx, NY · Anesthesiology | $1.9M |
| 17 | University Physicians Incorporated Aurora, CO · Anesthesiology | $1.8M |
| 18 | Presbyterian Healthcare Services Albuquerque, NM · Surgery | $1.8M |
| 19 | 1457396541 | $1.7M |
| 20 | 1942377379 | $1.7M |
Showing top 20 of 11K providers billing this code