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#5910 of 11K

S0197

HCPCS Procedure Code

HCPCS code S0197 is the #5,910 most-billed Medicaid procedure code, with $120K in payments across 53K claims from 2018–2024. The national median cost per claim is $1.50.

Total Paid

$120K

0.00% of all spending

Total Claims

53K

Providers

62

Avg Cost/Claim

$2

National Cost Distribution

How much do providers bill per claim for S0197? Based on 42 providers billing this code nationally.

Median

$1.50

Average

$2.28

Std Dev

$3.58

Max

$21.40

Percentile Distribution (Cost per Claim)

p10
$0.78
p25
$1.26
Median
$1.50
p75
$1.56
p90
$1.79
p95
$8.58
p99
$16.65

50% of providers bill between $1.26 and $1.56 per claim for this code.

90% bill between $0.78 and $1.79.

Top 1% bill above $16.65.

About This Procedure

HCPCS code S0197 was billed by 62 providers across 53K claims, totaling $120K in Medicaid payments from 2018–2024. This code was used for 38K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$1.50

Providers Billing

42

National Spending

$120K

Avg/Median Ratio

1.52×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for S0197

#ProviderTotal Paid
11386636165$22K
2Contra Costa County

Martinez, CA · Clinic/Center Federally Qualified Health Center (FQHC)

$16K
3Contra Costa County

Pittsburg, CA · Clinic/Center Federally Qualified Health Center (FQHC)

$14K
4Contra Costa County

San Pablo, CA · Clinic/Center Federally Qualified Health Center (FQHC)

$7K
51609913441$6K
61033256573$5K
71639129372$5K
8Planned Parenthood/orange And San Bernardino Counties, Inc.

Orange, CA · Clinic/Center, Ambulatory Family Planning Facility

$4K
91285937631$4K
101184674830$4K
111235189978$4K
121750325098$4K
131043241821$3K
141578599809$3K
151043354111$2K
161548210297$2K
171265766166$2K
181265668784$2K
191992873947$1K
201962597807$1K

Showing top 20 of 62 providers billing this code