#3370 of 11K

99475

HCPCS Procedure Code

HCPCS code 99475 is the #3,370 most-billed Medicaid procedure code, with $1.8M in payments across 3,766 claims from 2018–2024. The national median cost per claim is $477.80.

Total Paid

$1.8M

0.00% of all spending

Total Claims

3,766

Providers

Avg Cost/Claim

$488

National Cost Distribution

How much do providers bill per claim for 99475? Based on 23 providers billing this code nationally.

Median

$477.80

Average

$521.73

Std Dev

$290.96

Max

$1,529.93

Percentile Distribution (Cost per Claim)

p10

$352.06

p25

$385.86

Median

$477.80

p75

$546.89

p90

$830.35

p95

$951.56

p99

$1,404.45

50% of providers bill between $385.86 and $546.89 per claim for this code.

90% bill between $352.06 and $830.35.

Top 1% bill above $1,404.45.

About This Procedure

HCPCS code 99475 was billed by 23 providers across 3,766 claims, totaling $1.8M in Medicaid payments from 2018–2024. This code was used for 3,559 unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$477.80

Providers Billing

National Spending

$1.8M

Avg/Median Ratio

1.09×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 99475

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1811920549	$697K	$474.24	1.0× median	Below Median
2	Spectrum Health Primary Care Partners Grand Rapids, MI · Psychologist, Clinical Child & Adolescent	$525K	$464.66	1.0× median	Below Median
3	1801869250	$113K	$879.34	1.8× median	Top 10%
4	1629001169	$88K	$477.80	1.0× median	Above Median
5	1023237518	$63K	$452.98	0.9× median	Below Median
6	1669454617	$61K	$1,529.93	3.2× median	Top 1%
7	1336482256	$57K	$389.85	0.8× median	Below Median
8	1891156741	$50K	$387.73	0.8× median	Below Median
9	1619412376	$48K	$494.52	1.0× median	Above Median
10	1447331038	$16K	$376.36	0.8× median	Below Median
11	1497850291	$15K	$538.37	1.1× median	Above Median
12	1437137064	$15K	$504.68	1.1× median	Above Median
13	William Beaumont Hospital Royal Oak, MI · Internal Medicine, Cardiovascular Disease	$14K	$555.42	1.2× median	Above 75th
14	Ou Health Partners, Inc Oklahoma City, OK · Clinic/Center, Multi-Specialty	$14K	$959.59	2.0× median	Top 10%
15	1457396541	$11K	$566.31	1.2× median	Above 75th
16	West Virginia University Medical Corporation Morgantown, WV · Anesthesiology	$10K	$367.42	0.8× median	Below Median
17	1477537892	$10K	$348.21	0.7× median	Below Median
18	University Physicians Incorporated Aurora, CO · Anesthesiology	$8K	$634.39	1.3× median	Above 75th
19	Saint Peter's University Hospital New Brunswick, NJ · General Acute Care Hospital	$8K	$500.41	1.0× median	Above Median
20	Phoenix Children's Hospital Phoenix, AZ · Pediatrics	$7K	$525.75	1.1× median	Above Median

Showing top 20 of 23 providers billing this code

Related Procedures

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