99245
Office consultation, high complexity
Office consultation, high complexity is the #765 most-billed Medicaid procedure code, with $85.4M in payments across 645K claims from 2018–2024. The national median cost per claim is $143.30.
Total Paid
$85.4M
0.01% of all spending
Total Claims
645K
Providers
1K
Avg Cost/Claim
$132
National Cost Distribution
How much do providers bill per claim for 99245? Based on 1K providers billing this code nationally.
Median
$143.30
Average
$140.65
Std Dev
$77.37
Max
$1,567.24
Percentile Distribution (Cost per Claim)
50% of providers bill between $102.38 and $177.11 per claim for this code.
90% bill between $45.01 and $215.43.
Top 1% bill above $332.23.
About This Procedure
HCPCS code 99245 (Office consultation, high complexity) was billed by 1K providers across 645K claims, totaling $85.4M in Medicaid payments from 2018–2024. This code was used for 591K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$143.30
Providers Billing
1K
National Spending
$85.4M
Avg/Median Ratio
0.98×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 99245
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1265813125 | $9.5M |
| 2 | 1376565952 | $1.4M |
| 3 | 1356377576 | $1.3M |
| 4 | 1447640750 | $1.3M |
| 5 | 1114025103 | $1.3M |
| 6 | 1902379670 | $1.1M |
| 7 | 1497168546 | $1.1M |
| 8 | 1366912586 | $1.1M |
| 9 | Phoenix Children's Hospital Phoenix, AZ · Pediatrics | $1.1M |
| 10 | 1780014761 | $935K |
| 11 | 1437555265 | $860K |
| 12 | Cook Children's Physician Network Fort Worth, TX · Medical Genetics, Clinical Genetics (M.D.) | $825K |
| 13 | Spectrum Health Primary Care Partners Grand Rapids, MI · Psychologist, Clinical Child & Adolescent | $824K |
| 14 | 1407969371 | $812K |
| 15 | Yale University New Haven, CT · Internal Medicine | $767K |
| 16 | 1982678496 | $759K |
| 17 | 1104122621 | $747K |
| 18 | 1043260474 | $719K |
| 19 | 1780800128 | $691K |
| 20 | 1922074434 | $652K |
Showing top 20 of 1K providers billing this code