#5273 of 11K

99374

HCPCS Procedure Code

HCPCS code 99374 is the #5,273 most-billed Medicaid procedure code, with $243K in payments across 5,670 claims from 2018–2024. The national median cost per claim is $25.00. Costs vary widely — the 90th percentile is $60.69 per claim, 2.4× the median.

Total Paid

$243K

0.00% of all spending

Total Claims

5,670

Providers

Avg Cost/Claim

$43

National Cost Distribution

How much do providers bill per claim for 99374? Based on 18 providers billing this code nationally.

Median

$25.00

Average

$102.07

Std Dev

$326.13

Max

$1,406.07

Percentile Distribution (Cost per Claim)

p10

$2.45

p25

$7.05

Median

$25.00

p75

$48.81

p90

$60.69

p95

$263.87

p99

$1,177.63

50% of providers bill between $7.05 and $48.81 per claim for this code.

90% bill between $2.45 and $60.69.

Top 1% bill above $1,177.63.

About This Procedure

HCPCS code 99374 was billed by 26 providers across 5,670 claims, totaling $243K in Medicaid payments from 2018–2024. This code was used for 5,218 unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$25.00

Providers Billing

National Spending

$243K

Avg/Median Ratio

4.08×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for 99374

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1598844805	$74K	$57.50	2.3× median	Above 75th
2	1851699110	$48K	$1,406.07	56.2× median	Top 1%
3	1598138943	$29K	$33.46	1.3× median	Above Median
4	1093122384	$24K	$62.30	2.5× median	Top 10%
5	1952727109	$23K	$60.00	2.4× median	Above 75th
6	1346203502	$13K	$52.23	2.1× median	Above 75th
7	1053344473	$11K	$22.44	0.9× median	Below Median
8	1952363699	$8K	$13.70	0.5× median	Below Median
9	1003882812	$6K	$38.58	1.5× median	Above Median
10	1144677568	$3K	$27.76	1.1× median	Above Median
11	1306186994	$2K	$27.56	1.1× median	Above Median
12	1598236408	$2K	$5.98	0.2× median	Below Median
13	1194711358	$730	$10.28	0.4× median	Below Median
14	1093062937	$176	$11.75	0.5× median	Below Median
15	1760811681	$120	$3.24	0.1× median	Below Median
16	1780800128	$89	$0.60	0.0× median	Below Median
17	1538393053	$62	$3.64	0.1× median	Below Median
18	1871788513	$50	$0.22	0.0× median	Below Median
19	North Shore-lij Medical Pc Great Neck, NY · Urology	$0	$0.00	0.0× median	Below Median
20	1790998953	$0	$0.00	0.0× median	Below Median

Showing top 20 of 26 providers billing this code

Related Procedures

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