#2764 of 11K

M0298

HCPCS Procedure Code

HCPCS code M0298 is the #2,764 most-billed Medicaid procedure code, with $3.8M in payments across 240K claims from 2018–2024. The national median cost per claim is $13.85.

Total Paid

$3.8M

0.00% of all spending

Total Claims

240K

Providers

147

Avg Cost/Claim

$16

National Cost Distribution

How much do providers bill per claim for M0298? Based on 147 providers billing this code nationally.

Median

$13.85

Average

$16.32

Std Dev

$8.90

Max

$68.83

Percentile Distribution (Cost per Claim)

p10

$9.12

p25

$11.02

Median

$13.85

p75

$18.26

p90

$25.04

p95

$31.81

p99

$52.67

50% of providers bill between $11.02 and $18.26 per claim for this code.

90% bill between $9.12 and $25.04.

Top 1% bill above $52.67.

About This Procedure

HCPCS code M0298 was billed by 147 providers across 240K claims, totaling $3.8M in Medicaid payments from 2018–2024. This code was used for 80K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$13.85

Providers Billing

147

National Spending

$3.8M

Avg/Median Ratio

1.18×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for M0298

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Daybreak Community Services Texas Llc Fort Worth, TX · Community Based Residential Treatment Facility Intellectual and/or Developmental Disabilities	$840K	$16.54	1.2× median	Above Median
2	St. Giles Living Centers, Inc. Fort Worth, TX · Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	$202K	$17.70	1.3× median	Above Median
3	1871794933	$155K	$16.61	1.2× median	Above Median
4	1316002439	$117K	$16.20	1.2× median	Above Median
5	Lifetime Living Inc. San Antonio, TX · Case Management	$116K	$36.84	2.7× median	Top 10%
6	1790860666	$113K	$17.54	1.3× median	Above Median
7	1548315351	$80K	$68.83	5.0× median	Top 1%
8	1205037900	$76K	$12.88	0.9× median	Below Median
9	1801838461	$76K	$15.48	1.1× median	Above Median
10	1891823381	$69K	$18.57	1.3× median	Above 75th
11	1134320294	$67K	$16.86	1.2× median	Above Median
12	Berry Family Services Rowlett, TX · Case Management	$64K	$11.13	0.8× median	Below Median
13	1518062520	$64K	$17.35	1.3× median	Above Median
14	1235431453	$61K	$17.61	1.3× median	Above Median
15	D&s Residential Services, Lp Austin, TX · Intermediate Care Facility, Intellectual Disabilities	$60K	$11.63	0.8× median	Below Median
16	1831217710	$59K	$10.05	0.7× median	Below Median
17	Abiding Choice Inc Rockdale, TX · Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	$57K	$13.68	1.0× median	Below Median
18	1295254159	$44K	$17.48	1.3× median	Above Median
19	1427259241	$42K	$12.58	0.9× median	Below Median
20	1578551347	$40K	$15.66	1.1× median	Above Median

Showing top 20 of 147 providers billing this code

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