#1423 of 11K

99253

HCPCS Procedure Code

HCPCS code 99253 is the #1,423 most-billed Medicaid procedure code, with $23.7M in payments across 366K claims from 2018–2024. The national median cost per claim is $55.16.

Total Paid

$23.7M

0.00% of all spending

Total Claims

366K

Providers

Avg Cost/Claim

$65

National Cost Distribution

How much do providers bill per claim for 99253? Based on 1K providers billing this code nationally.

Median

$55.16

Average

$64.15

Std Dev

$62.23

Max

$1,299.73

Percentile Distribution (Cost per Claim)

p10

$33.02

p25

$42.50

Median

$55.16

p75

$76.68

p90

$99.78

p95

$114.01

p99

$164.03

50% of providers bill between $42.50 and $76.68 per claim for this code.

90% bill between $33.02 and $99.78.

Top 1% bill above $164.03.

About This Procedure

HCPCS code 99253 was billed by 1K providers across 366K claims, totaling $23.7M in Medicaid payments from 2018–2024. This code was used for 332K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$55.16

Providers Billing

National Spending

$23.7M

Avg/Median Ratio

1.16×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 99253

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Hennepin Healthcare System Inc Minneapolis, MN · General Acute Care Hospital	$955K	$84.53	1.5× median	Above 75th
2	1588689483	$871K	$114.41	2.1× median	Top 10%
3	1548477805	$773K	$76.47	1.4× median	Above Median
4	Spectrum Health Primary Care Partners Grand Rapids, MI · Psychologist, Clinical Child & Adolescent	$704K	$59.55	1.1× median	Above Median
5	County Of San Diego San Diego, CA · Public Health or Welfare	$578K	$1,133.27	20.5× median	Top 1%
6	1881627438	$570K	$49.72	0.9× median	Below Median
7	1316099898	$521K	$176.50	3.2× median	Top 1%
8	1740310689	$474K	$45.47	0.8× median	Below Median
9	1447299797	$464K	$61.61	1.1× median	Above Median
10	County Of Fresno Fresno, CA · Clinic/Center Mental Health (Including Community Mental Health Center)	$458K	$1,299.73	23.6× median	Top 1%
11	Texas Children's Physician Group Houston, TX · Pediatrics	$401K	$99.55	1.8× median	Above 75th
12	Magella Medical Associates Billing, Inc. Round Rock, TX · Obstetrics & Gynecology, Maternal & Fetal Medicine	$385K	$90.17	1.6× median	Above 75th
13	1922074434	$337K	$71.58	1.3× median	Above Median
14	1750560322	$312K	$83.43	1.5× median	Above 75th
15	District Medical Group, Inc Phoenix, AZ · Anesthesiology	$282K	$84.57	1.5× median	Above 75th
16	1225582620	$276K	$86.05	1.6× median	Above 75th
17	1750307393	$272K	$59.70	1.1× median	Above Median
18	1053329581	$271K	$29.29	0.5× median	Below Median
19	1922073535	$209K	$80.83	1.5× median	Above 75th
20	1831218627	$208K	$109.11	2.0× median	Top 10%

Showing top 20 of 1K 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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