#346 of 11K

99396

Preventive medicine, established patient, age 40-64

Preventive medicine, established patient, age 40-64 is the #346 most-billed Medicaid procedure code, with $379.0M in payments across 6.2M claims from 2018–2024. The national median cost per claim is $76.06.

Total Paid

$379.0M

0.03% of all spending

Total Claims

6.2M

Providers

11K

Avg Cost/Claim

$62

National Cost Distribution

How much do providers bill per claim for 99396? Based on 9K providers billing this code nationally.

Median

$76.06

Average

$70.85

Std Dev

$41.63

Max

$395.64

Percentile Distribution (Cost per Claim)

p10

$6.51

p25

$42.22

Median

$76.06

p75

$95.92

p90

$119.51

p95

$129.33

p99

$178.72

50% of providers bill between $42.22 and $95.92 per claim for this code.

90% bill between $6.51 and $119.51.

Top 1% bill above $178.72.

About This Procedure

HCPCS code 99396 (Preventive medicine, established patient, age 40-64) was billed by 11K providers across 6.2M claims, totaling $379.0M in Medicaid payments from 2018–2024. This code was used for 5.7M unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$76.06

Providers Billing

National Spending

$379.0M

Avg/Median Ratio

0.93×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 99396

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Chinatown True Care Medical Pllc New York, NY · Family Medicine	$5.5M	$106.91	1.4× median	Above 75th
2	1144203498	$3.6M	$57.55	0.8× median	Below Median
3	Montefiore Medical Center Bronx, NY · General Acute Care Hospital	$3.1M	$113.75	1.5× median	Above 75th
4	1689009854	$3.0M	$86.88	1.1× median	Above Median
5	The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital	$2.6M	$123.10	1.6× median	Top 10%
6	Optum Medical Care Of New Jersey Pc Secaucus, NJ · Durable Medical Equipment & Medical Supplies	$2.4M	$107.12	1.4× median	Above 75th
7	Nyu Langone Hospitals Brooklyn, NY · General Acute Care Hospital	$2.4M	$105.96	1.4× median	Above 75th
8	William Beaumont Hospital Royal Oak, MI · Internal Medicine, Cardiovascular Disease	$2.3M	$91.35	1.2× median	Above Median
9	The Metrohealth System Cleveland, OH · General Acute Care Hospital	$2.3M	$116.38	1.5× median	Above 75th
10	Montefiore Medical Center Bronx, NY · Anesthesiology	$2.2M	$144.43	1.9× median	Top 10%
11	Spectrum Health Primary Care Partners Grand Rapids, MI · Psychologist, Clinical Child & Adolescent	$2.0M	$89.06	1.2× median	Above Median
12	1003829441	$1.9M	$82.26	1.1× median	Above Median
13	Jamaica Hospital Richmond Hill, NY · General Acute Care Hospital	$1.9M	$119.82	1.6× median	Top 10%
14	1437161437	$1.9M	$84.61	1.1× median	Above Median
15	Sun River Health Inc. Peekskill, NY · Clinic/Center Federally Qualified Health Center (FQHC)	$1.6M	$80.77	1.1× median	Above Median
16	1457540056	$1.6M	$131.11	1.7× median	Top 10%
17	1447438197	$1.6M	$127.96	1.7× median	Top 10%
18	Park Nicollet Clinic St Louis Park, MN · Obstetrics & Gynecology	$1.5M	$81.76	1.1× median	Above Median
19	1295023547	$1.3M	$93.53	1.2× median	Above Median
20	1811226749	$1.2M	$87.29	1.1× median	Above Median

Showing top 20 of 11K 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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