#4690 of 11K

99415

HCPCS Procedure Code

HCPCS code 99415 is the #4,690 most-billed Medicaid procedure code, with $448K in payments across 21K claims from 2018–2024. The national median cost per claim is $5.25. Costs vary widely — the 90th percentile is $1,046.68 per claim, 199.4× the median.

Total Paid

$448K

0.00% of all spending

Total Claims

21K

Providers

Avg Cost/Claim

$21

National Cost Distribution

How much do providers bill per claim for 99415? Based on 47 providers billing this code nationally.

Median

$5.25

Average

$185.11

Std Dev

$485.19

Max

$1,846.05

Percentile Distribution (Cost per Claim)

p10

$0.56

p25

$2.96

Median

$5.25

p75

$10.86

p90

$1,046.68

p95

$1,468.18

p99

$1,732.79

50% of providers bill between $2.96 and $10.86 per claim for this code.

90% bill between $0.56 and $1,046.68.

Top 1% bill above $1,732.79.

About This Procedure

HCPCS code 99415 was billed by 52 providers across 21K claims, totaling $448K in Medicaid payments from 2018–2024. This code was used for 13K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$5.25

Providers Billing

National Spending

$448K

Avg/Median Ratio

35.26×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for 99415

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Los Angeles County Department Of Mental Health Los Angeles, CA · Clinic/Center, Mental Health (Including Community Mental Health Center)	$143K	$1,051.92	200.4× median	Top 10%
2	Santa Barbara County Auditor Santa Barbara, CA · Psychologist	$107K	$1,043.18	198.7× median	Above 75th
3	1942999255	$32K	$5.25	1.0× median	Above Median
4	County Of Riverside Riverside, CA · Community/Behavioral Health	$28K	$1,846.05	351.6× median	Top 1%
5	1023139516	$22K	$1,599.84	304.7× median	Top 10%
6	County Of Solano Fairfield, CA · Public Health or Welfare	$21K	$1,477.67	281.5× median	Top 10%
7	County Of Sacramento Sacramento, CA · Clinic/Center Adult Mental Health	$20K	$1,446.03	275.4× median	Top 10%
8	1235295551	$13K	$3.80	0.7× median	Below Median
9	1083146013	$10K	$9.67	1.8× median	Above Median
10	1740283613	$9K	$12.04	2.3× median	Above 75th
11	1336259118	$6K	$5.76	1.1× median	Above Median
12	1831417153	$5K	$4.91	0.9× median	Below Median
13	1669429577	$5K	$5.54	1.1× median	Above Median
14	1558792283	$4K	$30.37	5.8× median	Above 75th
15	1689979569	$4K	$7.89	1.5× median	Above Median
16	1033548581	$4K	$4.29	0.8× median	Below Median
17	1104068113	$3K	$9.17	1.7× median	Above Median
18	1205835634	$2K	$12.67	2.4× median	Above 75th
19	1124406129	$2K	$5.01	1.0× median	Below Median
20	1730777053	$1K	$4.52	0.9× median	Below Median

Showing top 20 of 52 providers billing this code

Related Procedures

99406$36.4M 99417$33.2M 99408$30.5M 99423Online digital E/M, 21+ min$13.6M 99407$9.2M

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