#1167 of 11K

99219

HCPCS Procedure Code

HCPCS code 99219 is the #1,167 most-billed Medicaid procedure code, with $35.9M in payments across 457K claims from 2018–2024. The national median cost per claim is $63.35.

Total Paid

$35.9M

0.00% of all spending

Total Claims

457K

Providers

Avg Cost/Claim

$79

National Cost Distribution

How much do providers bill per claim for 99219? Based on 1K providers billing this code nationally.

Median

$63.35

Average

$71.22

Std Dev

$99.02

Max

$2,780.38

Percentile Distribution (Cost per Claim)

p10

$29.29

p25

$42.81

Median

$63.35

p75

$80.14

p90

$103.80

p95

$120.97

p99

$311.42

50% of providers bill between $42.81 and $80.14 per claim for this code.

90% bill between $29.29 and $103.80.

Top 1% bill above $311.42.

About This Procedure

HCPCS code 99219 was billed by 1K providers across 457K claims, totaling $35.9M in Medicaid payments from 2018–2024. This code was used for 397K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$63.35

Providers Billing

National Spending

$35.9M

Avg/Median Ratio

1.12×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 99219

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Children's Hospital Medical Center Cincinnati, OH · Clinic/Center, Primary Care	$3.5M	$356.82	5.6× median	Top 1%
2	Children's Hospital Corporation Boston, MA · Clinic/Center	$1.5M	$123.99	2.0× median	Top 10%
3	Cook Children's Physician Network Fort Worth, TX · Medical Genetics, Clinical Genetics (M.D.)	$606K	$87.40	1.4× median	Above 75th
4	1871047712	$568K	$172.08	2.7× median	Top 10%
5	1417961137	$547K	$73.34	1.2× median	Above Median
6	1598906166	$543K	$108.90	1.7× median	Top 10%
7	Hennepin Healthcare System Inc Minneapolis, MN · General Acute Care Hospital	$541K	$91.56	1.4× median	Above 75th
8	Beth Israel Deaconess Medical Center, Inc. Boston, MA · General Acute Care Hospital	$491K	$214.99	3.4× median	Top 10%
9	Grossmont Hospital Corporation La Mesa, CA · General Acute Care Hospital	$484K	$632.22	10.0× median	Top 1%
10	1124374822	$393K	$68.26	1.1× median	Above Median
11	1124078696	$357K	$165.43	2.6× median	Top 10%
12	1396864542	$356K	$1,546.25	24.4× median	Top 1%
13	Spectrum Health Primary Care Partners Grand Rapids, MI · Psychologist, Clinical Child & Adolescent	$350K	$68.51	1.1× median	Above Median
14	1689670259	$350K	$132.16	2.1× median	Top 10%
15	1225192610	$349K	$52.60	0.8× median	Below Median
16	1073827101	$347K	$71.69	1.1× median	Above Median
17	1811920549	$347K	$70.87	1.1× median	Above Median
18	1275988321	$342K	$109.46	1.7× median	Top 10%
19	1245474329	$292K	$54.53	0.9× median	Below Median
20	1790976199	$291K	$74.98	1.2× median	Above Median

Showing top 20 of 1K providers billing this code

Related Procedures

99213Office/outpatient visit, est. patient, low-mod complexity$33.00B 99214Office/outpatient visit, est. patient, mod-high complexity$29.91B 99212Office/outpatient visit, low complexity$3.85B 99215Office/outpatient visit, high complexity$2.77B 99211Office/outpatient visit, minimal complexity$1.73B

← All procedures Top providers →