#2419 of 11K

99397

HCPCS Procedure Code

HCPCS code 99397 is the #2,419 most-billed Medicaid procedure code, with $5.9M in payments across 224K claims from 2018–2024. The national median cost per claim is $22.92. Costs vary widely — the 90th percentile is $87.52 per claim, 3.8× the median.

Total Paid

$5.9M

0.00% of all spending

Total Claims

224K

Providers

1,043

Avg Cost/Claim

$26

National Cost Distribution

How much do providers bill per claim for 99397? Based on 821 providers billing this code nationally.

Median

$22.92

Average

$37.08

Std Dev

$41.92

Max

$350.00

Percentile Distribution (Cost per Claim)

p10

$1.77

p25

$6.18

Median

$22.92

p75

$57.97

p90

$87.52

p95

$108.34

p99

$157.22

50% of providers bill between $6.18 and $57.97 per claim for this code.

90% bill between $1.77 and $87.52.

Top 1% bill above $157.22.

About This Procedure

HCPCS code 99397 was billed by 1,043 providers across 224K claims, totaling $5.9M in Medicaid payments from 2018–2024. This code was used for 200K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$22.92

Providers Billing

821

National Spending

$5.9M

Avg/Median Ratio

1.62×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for 99397

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1013102326	$186K	$104.82	4.6× median	Top 10%
2	Group Health Plan, Inc. Minneapolis, MN · Clinic/Center, Multi-Specialty	$161K	$96.36	4.2× median	Top 10%
3	1629045778	$158K	$62.31	2.7× median	Above 75th
4	Park Nicollet Clinic St Louis Park, MN · Obstetrics & Gynecology	$156K	$89.79	3.9× median	Top 10%
5	1457304966	$131K	$179.24	7.8× median	Top 1%
6	1902066574	$117K	$84.25	3.7× median	Above 75th
7	Montefiore Medical Center Bronx, NY · General Acute Care Hospital	$104K	$109.63	4.8× median	Top 10%
8	1740259530	$104K	$151.04	6.6× median	Top 10%
9	1215971262	$102K	$61.86	2.7× median	Above 75th
10	Jamaica Hospital Richmond Hill, NY · General Acute Care Hospital	$99K	$78.14	3.4× median	Above 75th
11	Medical Associates Of Ebnhc East Boston, MA · Clinic/Center, Community Health	$94K	$68.47	3.0× median	Above 75th
12	1144523622	$92K	$83.18	3.6× median	Above 75th
13	Cambridge Public Health Commission Cambridge, MA · General Acute Care Hospital	$86K	$44.72	2.0× median	Above Median
14	The Metrohealth System Cleveland, OH · General Acute Care Hospital	$77K	$79.42	3.5× median	Above 75th
15	1437196359	$74K	$108.25	4.7× median	Top 10%
16	Spectrum Health Primary Care Partners Grand Rapids, MI · Psychologist, Clinical Child & Adolescent	$72K	$43.45	1.9× median	Above Median
17	1841373800	$71K	$280.98	12.3× median	Top 1%
18	1003839655	$67K	$65.61	2.9× median	Above 75th
19	The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital	$67K	$90.32	3.9× median	Top 10%
20	Nyu Langone Hospitals Brooklyn, NY · General Acute Care Hospital	$63K	$76.14	3.3× median	Above 75th

Showing top 20 of 1,043 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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