#870 of 11K

99385

Preventive visit, new patient, 18-39 yr

Preventive visit, new patient, 18-39 yr is the #870 most-billed Medicaid procedure code, with $65.0M in payments across 1.0M claims from 2018–2024. The national median cost per claim is $76.22.

Total Paid

$65.0M

0.01% of all spending

Total Claims

1.0M

Providers

Avg Cost/Claim

$65

National Cost Distribution

How much do providers bill per claim for 99385? Based on 3K providers billing this code nationally.

Median

$76.22

Average

$75.10

Std Dev

$44.99

Max

$401.08

Percentile Distribution (Cost per Claim)

p10

$9.48

p25

$46.45

Median

$76.22

p75

$100.78

p90

$124.25

p95

$144.02

p99

$199.79

50% of providers bill between $46.45 and $100.78 per claim for this code.

90% bill between $9.48 and $124.25.

Top 1% bill above $199.79.

About This Procedure

HCPCS code 99385 (Preventive visit, new patient, 18-39 yr) was billed by 4K providers across 1.0M claims, totaling $65.0M in Medicaid payments from 2018–2024. This code was used for 912K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$76.22

Providers Billing

National Spending

$65.0M

Avg/Median Ratio

0.99×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 99385

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Montefiore Medical Center Bronx, NY · General Acute Care Hospital	$941K	$113.95	1.5× median	Above 75th
2	1205074739	$819K	$104.85	1.4× median	Above 75th
3	William Beaumont Hospital Royal Oak, MI · Internal Medicine, Cardiovascular Disease	$777K	$94.29	1.2× median	Above Median
4	1003829441	$753K	$85.75	1.1× median	Above Median
5	Group Health Plan, Inc. Minneapolis, MN · Clinic/Center, Multi-Specialty	$678K	$78.40	1.0× median	Above Median
6	1073827101	$653K	$94.79	1.2× median	Above Median
7	Sun River Health Inc. Peekskill, NY · Clinic/Center Federally Qualified Health Center (FQHC)	$649K	$91.50	1.2× median	Above Median
8	1437161437	$575K	$92.48	1.2× median	Above Median
9	1306954631	$568K	$73.95	1.0× median	Below Median
10	Park Nicollet Clinic St Louis Park, MN · Obstetrics & Gynecology	$548K	$80.42	1.1× median	Above Median
11	Boston Medical Center Corporation Boston, MA · General Acute Care Hospital	$491K	$98.78	1.3× median	Above Median
12	1952591547	$483K	$203.37	2.7× median	Top 1%
13	Lasante Health Center Inc Brooklyn, NY · Clinic/Center, Community Health	$443K	$104.26	1.4× median	Above 75th
14	1023119641	$437K	$57.76	0.8× median	Below Median
15	1386091486	$429K	$92.79	1.2× median	Above Median
16	New York University Boynton Beach, FL · Anesthesiology	$427K	$133.85	1.8× median	Top 10%
17	1053489260	$426K	$181.19	2.4× median	Top 10%
18	Spectrum Health Primary Care Partners Grand Rapids, MI · Psychologist, Clinical Child & Adolescent	$404K	$95.38	1.3× median	Above Median
19	Henry Ford Health System Detroit, MI · General Acute Care Hospital	$389K	$64.31	0.8× median	Below Median
20	1417959701	$375K	$147.66	1.9× median	Top 10%

Showing top 20 of 4K providers billing this code

Related Procedures

99392Preventive medicine, established patient, age 1-4$2.73B 99391Preventive medicine, established patient, infant (under 1)$2.47B 99393Preventive medicine, established patient, age 5-11$1.99B 99394Preventive medicine, established patient, age 12-17$1.24B 99395Preventive medicine, established patient, age 18-39$469.4M

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