#3720 of 11K

99315

HCPCS Procedure Code

HCPCS code 99315 is the #3,720 most-billed Medicaid procedure code, with $1.3M in payments across 40K claims from 2018–2024. The national median cost per claim is $14.17. Costs vary widely — the 90th percentile is $40.33 per claim, 2.8× the median.

Total Paid

$1.3M

0.00% of all spending

Total Claims

40K

Providers

243

Avg Cost/Claim

$32

National Cost Distribution

How much do providers bill per claim for 99315? Based on 232 providers billing this code nationally.

Median

$14.17

Average

$19.50

Std Dev

$17.92

Max

$121.63

Percentile Distribution (Cost per Claim)

p10

$3.54

p25

$7.15

Median

$14.17

p75

$25.87

p90

$40.33

p95

$50.84

p99

$88.33

50% of providers bill between $7.15 and $25.87 per claim for this code.

90% bill between $3.54 and $40.33.

Top 1% bill above $88.33.

About This Procedure

HCPCS code 99315 was billed by 243 providers across 40K claims, totaling $1.3M in Medicaid payments from 2018–2024. This code was used for 36K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$14.17

Providers Billing

232

National Spending

$1.3M

Avg/Median Ratio

1.38×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 99315

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1578709515	$592K	$87.37	6.2× median	Top 10%
2	1275576522	$56K	$53.81	3.8× median	Top 10%
3	1811063761	$49K	$27.88	2.0× median	Above 75th
4	1740210517	$39K	$27.25	1.9× median	Above 75th
5	1700925211	$38K	$22.32	1.6× median	Above Median
6	1609362375	$36K	$28.69	2.0× median	Above 75th
7	1528601952	$34K	$47.16	3.3× median	Top 10%
8	1184755118	$27K	$20.00	1.4× median	Above Median
9	1558844019	$23K	$102.46	7.2× median	Top 1%
10	1407306665	$15K	$24.63	1.7× median	Above Median
11	West Virginia University Medical Corporation Morgantown, WV · Anesthesiology	$14K	$55.85	3.9× median	Top 10%
12	1164759643	$13K	$28.75	2.0× median	Above 75th
13	1619263712	$13K	$7.52	0.5× median	Below Median
14	1932457546	$13K	$49.00	3.5× median	Top 10%
15	1093254419	$13K	$29.03	2.0× median	Above 75th
16	Community Physicians Of Indiana Inc Indianapolis, IN · Internal Medicine	$12K	$33.04	2.3× median	Above 75th
17	1942521810	$12K	$36.62	2.6× median	Above 75th
18	1407261092	$12K	$44.85	3.2× median	Top 10%
19	1053649376	$11K	$22.22	1.6× median	Above Median
20	1962440412	$11K	$9.41	0.7× median	Below Median

Showing top 20 of 243 providers billing this code

Related Procedures

99309Nursing facility care, subsequent, low complexity$781.4M 99308Nursing facility care, subsequent, straightforward$536.4M 99310$148.5M 99307$60.0M 99306$55.8M

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