#3605 of 11K

99251

HCPCS Procedure Code

HCPCS code 99251 is the #3,605 most-billed Medicaid procedure code, with $1.4M in payments across 40K claims from 2018–2024. The national median cost per claim is $28.38.

Total Paid

$1.4M

0.00% of all spending

Total Claims

40K

Providers

161

Avg Cost/Claim

$36

National Cost Distribution

How much do providers bill per claim for 99251? Based on 154 providers billing this code nationally.

Median

$28.38

Average

$30.35

Std Dev

$18.79

Max

$195.65

Percentile Distribution (Cost per Claim)

p10

$17.37

p25

$22.24

Median

$28.38

p75

$34.13

p90

$45.59

p95

$53.20

p99

$85.13

50% of providers bill between $22.24 and $34.13 per claim for this code.

90% bill between $17.37 and $45.59.

Top 1% bill above $85.13.

About This Procedure

HCPCS code 99251 was billed by 161 providers across 40K claims, totaling $1.4M in Medicaid payments from 2018–2024. This code was used for 34K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$28.38

Providers Billing

154

National Spending

$1.4M

Avg/Median Ratio

1.07×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 99251

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1003216391	$210K	$195.65	6.9× median	Top 1%
2	1154566560	$207K	$58.04	2.0× median	Top 10%
3	1962731745	$183K	$30.53	1.1× median	Above Median
4	1861409898	$79K	$31.13	1.1× median	Above Median
5	1619987302	$75K	$63.23	2.2× median	Top 10%
6	1336120153	$72K	$28.39	1.0× median	Above Median
7	1750667572	$66K	$26.23	0.9× median	Below Median
8	1225230592	$41K	$31.18	1.1× median	Above Median
9	1720497423	$35K	$22.86	0.8× median	Below Median
10	1770506024	$31K	$33.00	1.2× median	Above Median
11	1144234915	$27K	$30.72	1.1× median	Above Median
12	1902921364	$23K	$26.24	0.9× median	Below Median
13	1922074434	$20K	$34.23	1.2× median	Above 75th
14	Spectrum Health Primary Care Partners Grand Rapids, MI · Psychologist, Clinical Child & Adolescent	$20K	$25.66	0.9× median	Below Median
15	1285800342	$17K	$28.63	1.0× median	Above Median
16	1184294217	$16K	$31.77	1.1× median	Above Median
17	1710107883	$15K	$24.92	0.9× median	Below Median
18	District Medical Group, Inc Phoenix, AZ · Anesthesiology	$15K	$22.12	0.8× median	Below Median
19	1255305876	$14K	$34.54	1.2× median	Above 75th
20	Neo Natal Associates Plc Grand Rapids, MI · Pediatrics Neonatal-Perinatal Medicine	$14K	$27.40	1.0× median	Below Median

Showing top 20 of 161 providers billing this code

Related Procedures

99244Office or other outpatient consultation, moderate complexity$402.7M 99243Office or other outpatient consultation, low complexity$203.1M 99245Office consultation, high complexity$85.4M 99254$77.8M 99255$49.1M

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