99212
Office/outpatient visit, low complexity
Office/outpatient visit, low complexity is the #51 most-billed Medicaid procedure code, with $3.85B in payments across 92.3M claims from 2018–2024. The national median cost per claim is $25.06. Costs vary widely — the 90th percentile is $55.65 per claim, 2.2× the median.
Total Paid
$3.85B
0.35% of all spending
Total Claims
92.3M
Providers
49K
Avg Cost/Claim
$42
National Cost Distribution
How much do providers bill per claim for 99212? Based on 45K providers billing this code nationally.
Median
$25.06
Average
$33.63
Std Dev
$45.15
Max
$1,835.09
Percentile Distribution (Cost per Claim)
50% of providers bill between $16.12 and $36.97 per claim for this code.
90% bill between $5.14 and $55.65.
Top 1% bill above $203.57.
About This Procedure
HCPCS code 99212 (Office/outpatient visit, low complexity) was billed by 49K providers across 92.3M claims, totaling $3.85B in Medicaid payments from 2018–2024. This code was used for 76.1M unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$25.06
Providers Billing
45K
National Spending
$3.85B
Avg/Median Ratio
1.34×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 99212
| # | Provider | Total Paid |
|---|---|---|
| 1 | Chickasaw Nation Division Of Health ADA, OK · General Acute Care Hospital | $161.4M |
| 2 | Choctaw Nation Of Oklahoma Talihina, OK · General Acute Care Hospital Rural | $79.2M |
| 3 | Central Oklahoma American Indian Health Council Inc. Oklahoma City, OK · Clinic/Center Federally Qualified Health Center (FQHC) | $78.0M |
| 4 | Children's Hospital Washington, DC · General Acute Care Hospital Children | $58.1M |
| 5 | Dhhs Phs Naihs Shiprock Hospital Shiprock, NM · General Acute Care Hospital | $49.7M |
| 6 | 1396173449 | $40.3M |
| 7 | 1952377939 | $38.0M |
| 8 | City Medical Of Upper East Side Pllc New York, NY · Clinic/Center Urgent Care | $33.2M |
| 9 | 1730249186 | $30.5M |
| 10 | 1710953799 | $30.3M |
| 11 | Umass Memorial Medical Center, Inc. Worcester, MA · General Acute Care Hospital | $29.2M |
| 12 | Beth Israel Deaconess Medical Center, Inc. Boston, MA · General Acute Care Hospital | $25.8M |
| 13 | Dana-farber Cancer Institute, Inc. Boston, MA · General Acute Care Hospital | $25.4M |
| 14 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $25.4M |
| 15 | 1407822497 | $25.3M |
| 16 | Rector & Visitors Of The University Of Virginia Charlottesville, VA · General Acute Care Hospital | $23.8M |
| 17 | University Hospital Newark, NJ · General Acute Care Hospital | $22.7M |
| 18 | 1265518203 | $19.9M |
| 19 | New York Psychotherapy And Counseling Center Jamaica, NY · Community/Behavioral Health | $19.7M |
| 20 | 1649330242 | $18.0M |
Showing top 20 of 49K providers billing this code