Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

#4530 of 11K

99461

HCPCS Procedure Code

HCPCS code 99461 is the #4,530 most-billed Medicaid procedure code, with $529K in payments across 7,740 claims from 2018–2024. The national median cost per claim is $74.20.

Total Paid

$529K

0.00% of all spending

Total Claims

7,740

Providers

50

Avg Cost/Claim

$68

National Cost Distribution

How much do providers bill per claim for 99461? Based on 46 providers billing this code nationally.

Median

$74.20

Average

$70.73

Std Dev

$23.21

Max

$137.38

Percentile Distribution (Cost per Claim)

p10
$41.05
p25
$59.80
Median
$74.20
p75
$84.50
p90
$92.20
p95
$95.34
p99
$120.23

50% of providers bill between $59.80 and $84.50 per claim for this code.

90% bill between $41.05 and $92.20.

Top 1% bill above $120.23.

About This Procedure

HCPCS code 99461 was billed by 50 providers across 7,740 claims, totaling $529K in Medicaid payments from 2018–2024. This code was used for 7,268 unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$74.20

Providers Billing

46

National Spending

$529K

Avg/Median Ratio

0.95×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 99461

#ProviderTotal Paid
11093060238$80K
21376508788$67K
31790098416$65K
41538304134$54K
51538597349$41K
61790878569$36K
71851613939$33K
81457364994$22K
91972529808$20K
101770880924$13K
111164506358$11K
121134286131$7K
131437216645$7K
141104903749$6K
151982871729$6K
161720461882$5K
171033783451$5K
181164629267$4K
191740711449$4K
201861869117$3K

Showing top 20 of 50 providers billing this code