99497
HCPCS Procedure Code
HCPCS code 99497 is the #1,194 most-billed Medicaid procedure code, with $34.2M in payments across 1.7M claims from 2018–2024. The national median cost per claim is $10.99. Costs vary widely — the 90th percentile is $45.78 per claim, 4.2× the median.
Total Paid
$34.2M
0.00% of all spending
Total Claims
1.7M
Providers
4K
Avg Cost/Claim
$20
National Cost Distribution
How much do providers bill per claim for 99497? Based on 3K providers billing this code nationally.
Median
$10.99
Average
$18.60
Std Dev
$27.27
Max
$781.00
Percentile Distribution (Cost per Claim)
50% of providers bill between $3.72 and $25.80 per claim for this code.
90% bill between $1.03 and $45.78.
Top 1% bill above $83.68.
About This Procedure
HCPCS code 99497 was billed by 4K providers across 1.7M claims, totaling $34.2M in Medicaid payments from 2018–2024. This code was used for 1.4M unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$10.99
Providers Billing
3K
National Spending
$34.2M
Avg/Median Ratio
1.69×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for 99497
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1396749941 | $935K |
| 2 | 1154320299 | $925K |
| 3 | 1275576522 | $774K |
| 4 | 1538161443 | $743K |
| 5 | 1962685933 | $665K |
| 6 | 1578959318 | $583K |
| 7 | 1689009854 | $418K |
| 8 | 1184666570 | $382K |
| 9 | 1295178689 | $368K |
| 10 | 1669039533 | $360K |
| 11 | 1619244688 | $341K |
| 12 | 1538723531 | $319K |
| 13 | 1548538200 | $309K |
| 14 | 1356723605 | $308K |
| 15 | 1477532588 | $308K |
| 16 | 1093793101 | $298K |
| 17 | 1124693924 | $291K |
| 18 | 1487045530 | $282K |
| 19 | 1295165645 | $280K |
| 20 | 1144493461 | $273K |
Showing top 20 of 4K providers billing this code