#3456 of 11K

99426

HCPCS Procedure Code

HCPCS code 99426 is the #3,456 most-billed Medicaid procedure code, with $1.7M in payments across 107K claims from 2018–2024. The national median cost per claim is $10.06. Costs vary widely — the 90th percentile is $45.45 per claim, 4.5× the median.

Total Paid

$1.7M

0.00% of all spending

Total Claims

107K

Providers

174

Avg Cost/Claim

$16

National Cost Distribution

How much do providers bill per claim for 99426? Based on 129 providers billing this code nationally.

Median

$10.06

Average

$17.15

Std Dev

$18.08

Max

$70.43

Percentile Distribution (Cost per Claim)

p10

$0.80

p25

$2.66

Median

$10.06

p75

$29.14

p90

$45.45

p95

$53.00

p99

$63.23

50% of providers bill between $2.66 and $29.14 per claim for this code.

90% bill between $0.80 and $45.45.

Top 1% bill above $63.23.

About This Procedure

HCPCS code 99426 was billed by 174 providers across 107K claims, totaling $1.7M in Medicaid payments from 2018–2024. This code was used for 99K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$10.06

Providers Billing

129

National Spending

$1.7M

Avg/Median Ratio

1.70×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for 99426

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1902957970	$653K	$62.99	6.3× median	Top 10%
2	1699704809	$176K	$21.56	2.1× median	Above Median
3	1033803143	$73K	$44.12	4.4× median	Above 75th
4	1457735805	$52K	$32.93	3.3× median	Above 75th
5	1790421253	$50K	$39.04	3.9× median	Above 75th
6	1942866462	$50K	$70.43	7.0× median	Top 1%
7	1275257479	$48K	$42.09	4.2× median	Above 75th
8	1922440684	$44K	$13.00	1.3× median	Above Median
9	1295435873	$36K	$44.97	4.5× median	Above 75th
10	Mainegeneral Medical Center Augusta, ME · General Acute Care Hospital	$35K	$63.33	6.3× median	Top 1%
11	1376921460	$32K	$21.86	2.2× median	Above Median
12	1093158347	$29K	$52.77	5.2× median	Top 10%
13	1023781028	$24K	$19.43	1.9× median	Above Median
14	1417143488	$23K	$17.57	1.7× median	Above Median
15	1427095801	$23K	$44.46	4.4× median	Above 75th
16	1407483175	$19K	$2.26	0.2× median	Below Median
17	1598234056	$17K	$21.97	2.2× median	Above Median
18	1528483245	$17K	$4.95	0.5× median	Below Median
19	1770253452	$16K	$56.36	5.6× median	Top 10%
20	1134507189	$15K	$41.69	4.1× median	Above 75th

Showing top 20 of 174 providers billing this code

Related Procedures

99417$33.2M 99429$32.9M 99423Online digital E/M, 21+ min$13.6M 99421Online digital E/M, 5-10 min$6.2M 99422Online digital E/M, 11-20 min$4.2M

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