#2697 of 11K

D9996

HCPCS Procedure Code

HCPCS code D9996 is the #2,697 most-billed Medicaid procedure code, with $4.1M in payments across 200K claims from 2018–2024. The national median cost per claim is $11.15. Costs vary widely — the 90th percentile is $38.68 per claim, 3.5× the median.

Total Paid

$4.1M

0.00% of all spending

Total Claims

200K

Providers

289

Avg Cost/Claim

$20

National Cost Distribution

How much do providers bill per claim for D9996? Based on 142 providers billing this code nationally.

Median

$11.15

Average

$17.20

Std Dev

$27.69

Max

$202.40

Percentile Distribution (Cost per Claim)

p10

$0.54

p25

$4.67

Median

$11.15

p75

$14.71

p90

$38.68

p95

$62.57

p99

$160.10

50% of providers bill between $4.67 and $14.71 per claim for this code.

90% bill between $0.54 and $38.68.

Top 1% bill above $160.10.

About This Procedure

HCPCS code D9996 was billed by 289 providers across 200K claims, totaling $4.1M in Medicaid payments from 2018–2024. This code was used for 187K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$11.15

Providers Billing

142

National Spending

$4.1M

Avg/Median Ratio

1.54×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for D9996

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Whybee Brooklyn, NY · Case Management	$3.1M	$118.68	10.6× median	Top 10%
2	1225201460	$169K	$12.55	1.1× median	Above Median
3	1225545270	$115K	$25.74	2.3× median	Above 75th
4	1700214350	$90K	$26.24	2.4× median	Above 75th
5	1598262818	$59K	$44.10	4.0× median	Top 10%
6	1134439847	$58K	$12.49	1.1× median	Above Median
7	1285001065	$44K	$16.01	1.4× median	Above 75th
8	1154498053	$40K	$63.24	5.7× median	Top 10%
9	1184694291	$36K	$32.70	2.9× median	Above 75th
10	1619904836	$32K	$27.77	2.5× median	Above 75th
11	1699902247	$25K	$12.49	1.1× median	Above Median
12	1043854029	$24K	$25.17	2.3× median	Above 75th
13	1699842500	$19K	$87.72	7.9× median	Top 10%
14	1316353204	$18K	$12.00	1.1× median	Above Median
15	1710949318	$17K	$14.33	1.3× median	Above Median
16	1811448863	$15K	$10.06	0.9× median	Below Median
17	1649688797	$14K	$11.50	1.0× median	Above Median
18	1164403440	$13K	$12.56	1.1× median	Above Median
19	1497822209	$13K	$64.94	5.8× median	Top 10%
20	1225200074	$12K	$14.72	1.3× median	Above 75th

Showing top 20 of 289 providers billing this code

Related Procedures

D9999Unspecified adjunctive procedure, by report$350.8M D9993$89.2M D9995$4.0M D9990$2.4M D9994$1.8M

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