#1345 of 11K

99386

Preventive visit, new patient, 40-64 yr

Preventive visit, new patient, 40-64 yr is the #1,345 most-billed Medicaid procedure code, with $26.3M in payments across 377K claims from 2018–2024. The national median cost per claim is $87.82.

Total Paid

$26.3M

0.00% of all spending

Total Claims

377K

Providers

Avg Cost/Claim

$70

National Cost Distribution

How much do providers bill per claim for 99386? Based on 2K providers billing this code nationally.

Median

$87.82

Average

$85.02

Std Dev

$63.40

Max

$400.00

Percentile Distribution (Cost per Claim)

p10

$5.83

p25

$36.71

Median

$87.82

p75

$115.88

p90

$143.26

p95

$161.25

p99

$350.00

50% of providers bill between $36.71 and $115.88 per claim for this code.

90% bill between $5.83 and $143.26.

Top 1% bill above $350.00.

About This Procedure

HCPCS code 99386 (Preventive visit, new patient, 40-64 yr) was billed by 2K providers across 377K claims, totaling $26.3M in Medicaid payments from 2018–2024. This code was used for 348K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$87.82

Providers Billing

National Spending

$26.3M

Avg/Median Ratio

0.97×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 99386

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Montefiore Medical Center Bronx, NY · General Acute Care Hospital	$599K	$115.40	1.3× median	Above Median
2	1437161437	$475K	$109.70	1.2× median	Above Median
3	William Beaumont Hospital Royal Oak, MI · Internal Medicine, Cardiovascular Disease	$459K	$109.65	1.2× median	Above Median
4	1073827101	$418K	$109.19	1.2× median	Above Median
5	1003829441	$405K	$102.24	1.2× median	Above Median
6	Sun River Health Inc. Peekskill, NY · Clinic/Center Federally Qualified Health Center (FQHC)	$393K	$95.40	1.1× median	Above Median
7	1366768160	$369K	$346.57	3.9× median	Top 10%
8	New York University Boynton Beach, FL · Anesthesiology	$366K	$150.49	1.7× median	Top 10%
9	1457540056	$295K	$159.04	1.8× median	Top 10%
10	1770044208	$284K	$104.76	1.2× median	Above Median
11	1871195644	$279K	$245.84	2.8× median	Top 10%
12	Beth Israel Medical Center Brooklyn, NY · Psychiatric Unit	$274K	$140.90	1.6× median	Above 75th
13	1679883037	$268K	$138.56	1.6× median	Above 75th
14	The New York And Presbyterian Hospital New York, NY · General Acute Care Hospital	$268K	$174.77	2.0× median	Top 10%
15	Group Health Plan, Inc. Minneapolis, MN · Clinic/Center, Multi-Specialty	$263K	$90.19	1.0× median	Above Median
16	1336153295	$245K	$339.64	3.9× median	Top 10%
17	1205074739	$245K	$120.54	1.4× median	Above 75th
18	1295023547	$240K	$112.57	1.3× median	Above Median
19	Boston Medical Center Corporation Boston, MA · General Acute Care Hospital	$224K	$80.97	0.9× median	Below Median
20	Henry Ford Health System Detroit, MI · General Acute Care Hospital	$210K	$63.47	0.7× median	Below Median

Showing top 20 of 2K 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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