#75 of 11K

H0040

Assertive community treatment, face-to-face, per 15 minutes

Assertive community treatment, face-to-face, per 15 minutes is the #75 most-billed Medicaid procedure code, with $2.57B in payments across 13.2M claims from 2018–2024. The national median cost per claim is $266.41. Costs vary widely — the 90th percentile is $1,770.19 per claim, 6.6× the median.

Total Paid

$2.57B

0.24% of all spending

Total Claims

13.2M

Providers

599

Avg Cost/Claim

$195

National Cost Distribution

How much do providers bill per claim for H0040? Based on 562 providers billing this code nationally.

Median

$266.41

Average

$653.40

Std Dev

$657.29

Max

$2,231.21

Percentile Distribution (Cost per Claim)

p10

$53.43

p25

$176.03

Median

$266.41

p75

$1,219.31

p90

$1,770.19

p95

$1,877.84

p99

$2,057.63

50% of providers bill between $176.03 and $1,219.31 per claim for this code.

90% bill between $53.43 and $1,770.19.

Top 1% bill above $2,057.63.

About This Procedure

HCPCS code H0040 (Assertive community treatment, face-to-face, per 15 minutes) was billed by 599 providers across 13.2M claims, totaling $2.57B in Medicaid payments from 2018–2024. This code was used for 2.0M unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$266.41

Providers Billing

562

National Spending

$2.57B

Avg/Median Ratio

2.45×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for H0040

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Bridgeway Behavioral Health Services Elizabeth, NJ · Case Management	$62.4M	$1,537.53	5.8× median	Above 75th
2	Alabama Department Of Mental Health And Mental Retardation Montgomery, AL · Community/Behavioral Health	$37.0M	$36.23	0.1× median	Below Median
3	1922165117	$36.9M	$1,920.97	7.2× median	Top 10%
4	1831269315	$35.9M	$1,738.13	6.5× median	Above 75th
5	1881816643	$34.6M	$1,870.84	7.0× median	Top 10%
6	Gateway Healthcare Inc Pawtucket, RI · Day Training, Developmentally Disabled Services	$31.8M	$1,217.08	4.6× median	Above Median
7	Icl Act Team Central Brooklyn Brooklyn, NY · Case Management	$29.4M	$1,827.42	6.9× median	Top 10%
8	1346477403	$29.0M	$223.60	0.8× median	Below Median
9	1508012816	$28.0M	$1,930.00	7.2× median	Top 10%
10	The Providence Center Inc Providence, RI · Counselor, Mental Health	$27.2M	$1,094.68	4.1× median	Above Median
11	1386671535	$25.8M	$1,121.37	4.2× median	Above Median
12	1912079328	$23.9M	$435.99	1.6× median	Above Median
13	1285882928	$23.0M	$219.89	0.8× median	Below Median
14	1528059805	$22.4M	$1,780.27	6.7× median	Top 10%
15	1689799058	$21.6M	$1,440.22	5.4× median	Above 75th
16	1861514945	$19.8M	$166.27	0.6× median	Below Median
17	1144375767	$19.7M	$243.90	0.9× median	Below Median
18	1942412556	$19.3M	$1,061.61	4.0× median	Above Median
19	1528093242	$19.2M	$1,971.60	7.4× median	Top 10%
20	1598978074	$18.8M	$977.18	3.7× median	Above Median

Showing top 20 of 599 providers billing this code

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