#3942 of 11K

99498

HCPCS Procedure Code

HCPCS code 99498 is the #3,942 most-billed Medicaid procedure code, with $997K in payments across 29K claims from 2018–2024. The national median cost per claim is $15.46. Costs vary widely — the 90th percentile is $58.39 per claim, 3.8× the median.

Total Paid

$997K

0.00% of all spending

Total Claims

29K

Providers

129

Avg Cost/Claim

$34

National Cost Distribution

How much do providers bill per claim for 99498? Based on 94 providers billing this code nationally.

Median

$15.46

Average

$33.55

Std Dev

$94.24

Max

$907.64

Percentile Distribution (Cost per Claim)

p10

$1.87

p25

$6.82

Median

$15.46

p75

$35.62

p90

$58.39

p95

$72.85

p99

$173.67

50% of providers bill between $6.82 and $35.62 per claim for this code.

90% bill between $1.87 and $58.39.

Top 1% bill above $173.67.

About This Procedure

HCPCS code 99498 was billed by 129 providers across 29K claims, totaling $997K in Medicaid payments from 2018–2024. This code was used for 22K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$15.46

Providers Billing

National Spending

$997K

Avg/Median Ratio

2.17×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for 99498

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1043326531	$446K	$907.64	58.7× median	Top 1%
2	1124693924	$125K	$35.05	2.3× median	Above Median
3	1861719122	$72K	$41.70	2.7× median	Above 75th
4	1275576522	$35K	$43.44	2.8× median	Above 75th
5	1871955807	$34K	$32.34	2.1× median	Above Median
6	Medstar Medical Group Ii Llc Baltimore, MD · General Practice	$26K	$49.23	3.2× median	Above 75th
7	Spectrum Health Primary Care Partners Grand Rapids, MI · Psychologist, Clinical Child & Adolescent	$24K	$32.56	2.1× median	Above Median
8	1902855828	$22K	$60.72	3.9× median	Top 10%
9	1437675980	$18K	$57.82	3.7× median	Above 75th
10	1518962083	$17K	$111.98	7.2× median	Top 10%
11	1063468627	$15K	$23.87	1.5× median	Above Median
12	1497791297	$14K	$22.61	1.5× median	Above Median
13	1891313151	$13K	$72.46	4.7× median	Top 10%
14	1538723531	$11K	$38.59	2.5× median	Above 75th
15	1720520703	$8K	$41.53	2.7× median	Above 75th
16	1326490830	$8K	$54.67	3.5× median	Above 75th
17	1578958450	$7K	$49.05	3.2× median	Above 75th
18	1295202901	$7K	$30.06	1.9× median	Above Median
19	1033507033	$7K	$16.56	1.1× median	Above Median
20	1316486640	$7K	$4.24	0.3× median	Below Median

Showing top 20 of 129 providers billing this code

Related Procedures

99490Chronic care management services, 20 minutes per month$315.0M 99499Unlisted evaluation and management service$176.4M 99497$34.2M 99493$11.3M 99495$8.4M

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