#3150 of 11K

M0171

HCPCS Procedure Code

HCPCS code M0171 is the #3,150 most-billed Medicaid procedure code, with $2.4M in payments across 33K claims from 2018–2024. The national median cost per claim is $73.78.

Total Paid

$2.4M

0.00% of all spending

Total Claims

33K

Providers

Avg Cost/Claim

$72

National Cost Distribution

How much do providers bill per claim for M0171? Based on 29 providers billing this code nationally.

Median

$73.78

Average

$72.79

Std Dev

$8.17

Max

$93.52

Percentile Distribution (Cost per Claim)

p10

$62.84

p25

$69.12

Median

$73.78

p75

$77.51

p90

$79.36

p95

$83.40

p99

$91.43

50% of providers bill between $69.12 and $77.51 per claim for this code.

90% bill between $62.84 and $79.36.

Top 1% bill above $91.43.

About This Procedure

HCPCS code M0171 was billed by 29 providers across 33K claims, totaling $2.4M in Medicaid payments from 2018–2024. This code was used for 7K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$73.78

Providers Billing

National Spending

$2.4M

Avg/Median Ratio

0.99×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for M0171

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Berry Family Services Rowlett, TX · Case Management	$273K	$72.93	1.0× median	Below Median
2	1811039225	$209K	$63.46	0.9× median	Below Median
3	1235431453	$189K	$73.78	1.0× median	Above Median
4	Lifetime Living Inc. San Antonio, TX · Case Management	$168K	$75.80	1.0× median	Above Median
5	1417156100	$156K	$73.66	1.0× median	Below Median
6	1689756439	$154K	$93.52	1.3× median	Top 1%
7	Daybreak Community Services Texas Llc Fort Worth, TX · Community Based Residential Treatment Facility Intellectual and/or Developmental Disabilities	$141K	$69.12	0.9× median	Below Median
8	D&s Residential Services, Lp Austin, TX · Intermediate Care Facility, Intellectual Disabilities	$113K	$64.45	0.9× median	Below Median
9	1972700094	$100K	$72.77	1.0× median	Below Median
10	1629474820	$93K	$66.60	0.9× median	Below Median
11	Wellness Healthcare Solutions Inc. Desoto, TX · Day Training, Developmentally Disabled Services	$88K	$75.26	1.0× median	Above Median
12	1063614022	$84K	$60.37	0.8× median	Below Median
13	1578897849	$79K	$77.09	1.0× median	Above Median
14	1598084774	$73K	$69.71	0.9× median	Below Median
15	1922160571	$70K	$76.40	1.0× median	Above Median
16	1013297704	$68K	$77.51	1.1× median	Above Median
17	1356498745	$53K	$86.06	1.2× median	Top 10%
18	Kenmar Residential Hcs Services Inc. Round Rock, TX · Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	$47K	$64.15	0.9× median	Below Median
19	1598997926	$34K	$69.86	0.9× median	Below Median
20	1205037066	$33K	$79.09	1.1× median	Above 75th

Showing top 20 of 29 providers billing this code

Related Procedures

M0167$37.2M M0166$20.1M M0169$3.8M

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