99215
Office/outpatient visit, high complexity
Office/outpatient visit, high complexity is the #70 most-billed Medicaid procedure code, with $2.77B in payments across 29.6M claims from 2018–2024. The national median cost per claim is $74.09.
Total Paid
$2.77B
0.25% of all spending
Total Claims
29.6M
Providers
30K
Avg Cost/Claim
$94
National Cost Distribution
How much do providers bill per claim for 99215? Based on 28K providers billing this code nationally.
Median
$74.09
Average
$87.21
Std Dev
$94.52
Max
$1,870.97
Percentile Distribution (Cost per Claim)
50% of providers bill between $47.18 and $108.11 per claim for this code.
90% bill between $22.55 and $145.20.
Top 1% bill above $387.37.
About This Procedure
HCPCS code 99215 (Office/outpatient visit, high complexity) was billed by 30K providers across 29.6M claims, totaling $2.77B in Medicaid payments from 2018–2024. This code was used for 25.3M unique beneficiaries.
Risk Assessment
This procedure is featured in our investigation: Impossible Volume
Read the full analysis for context on billing patterns associated with this code.
Billing Statistics
Median Cost/Claim
$74.09
Providers Billing
28K
National Spending
$2.77B
Avg/Median Ratio
1.18×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 99215
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1891849725 | $42.0M |
| 2 | Los Angeles County Department Of Mental Health Los Angeles, CA · Clinic/Center, Mental Health (Including Community Mental Health Center) | $39.8M |
| 3 | Boston Medical Center Corporation Boston, MA · General Acute Care Hospital | $28.0M |
| 4 | 1265813125 | $21.2M |
| 5 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $17.0M |
| 6 | University Physicians Incorporated Aurora, CO · Anesthesiology | $16.6M |
| 7 | County Of San Bernardino San Bernardino, CA · Clinic/Center Rehabilitation Substance Use Disorder | $13.9M |
| 8 | Ideal Option, Pllc Pasco, WA · Preventive Medicine, Addiction Medicine | $12.6M |
| 9 | County Of Santa Clara San Jose, CA · Community/Behavioral Health | $12.0M |
| 10 | 1467454967 | $11.5M |
| 11 | Nationwide Children's Hospital Columbus, OH · General Acute Care Hospital | $11.3M |
| 12 | Medstar Washington Hospital Center Washington, DC · General Acute Care Hospital | $10.8M |
| 13 | Children's Specialized Hospital New Brunswick, NJ · Pediatrics | $10.4M |
| 14 | 1669617197 | $10.2M |
| 15 | Children's Hospital Medical Center Of Akron Akron, OH · General Acute Care Hospital Children | $10.1M |
| 16 | 1437555265 | $10.1M |
| 17 | County Of Sacramento Sacramento, CA · Clinic/Center Adult Mental Health | $9.9M |
| 18 | Texas Children's Physician Group Houston, TX · Pediatrics | $9.5M |
| 19 | 1326046467 | $9.2M |
| 20 | Hennepin Healthcare System Inc Minneapolis, MN · General Acute Care Hospital | $9.2M |
Showing top 20 of 30K providers billing this code