#2647 of 11K

S5115

Home modifications, per service

Home modifications, per service is the #2,647 most-billed Medicaid procedure code, with $4.4M in payments across 51K claims from 2018–2024. The national median cost per claim is $62.72. Costs vary widely — the 90th percentile is $163.02 per claim, 2.6× the median.

Total Paid

$4.4M

0.00% of all spending

Total Claims

51K

Providers

Avg Cost/Claim

$86

National Cost Distribution

How much do providers bill per claim for S5115? Based on 47 providers billing this code nationally.

Median

$62.72

Average

$91.88

Std Dev

$70.72

Max

$295.61

Percentile Distribution (Cost per Claim)

p10

$34.09

p25

$47.94

Median

$62.72

p75

$113.18

p90

$163.02

p95

$275.54

p99

$295.15

50% of providers bill between $47.94 and $113.18 per claim for this code.

90% bill between $34.09 and $163.02.

Top 1% bill above $295.15.

About This Procedure

HCPCS code S5115 (Home modifications, per service) was billed by 49 providers across 51K claims, totaling $4.4M in Medicaid payments from 2018–2024. This code was used for 22K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$62.72

Providers Billing

National Spending

$4.4M

Avg/Median Ratio

1.46×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for S5115

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1487014932	$1.1M	$127.98	2.0× median	Above 75th
2	Guardiantrac. Llc Sturgis, MI · Community/Behavioral Health	$528K	$47.62	0.8× median	Below Median
3	1538898879	$385K	$150.88	2.4× median	Above 75th
4	1467544833	$296K	$89.86	1.4× median	Above Median
5	1295184133	$293K	$149.95	2.4× median	Above 75th
6	1598701419	$210K	$171.30	2.7× median	Top 10%
7	1649606849	$170K	$76.59	1.2× median	Above Median
8	1518144088	$145K	$62.72	1.0× median	Below Median
9	1306372354	$131K	$83.57	1.3× median	Above Median
10	1942849492	$113K	$157.50	2.5× median	Above 75th
11	1679603286	$111K	$113.38	1.8× median	Above 75th
12	1245731173	$103K	$78.06	1.2× median	Above Median
13	1851307375	$77K	$45.51	0.7× median	Below Median
14	1881253037	$75K	$110.51	1.8× median	Above Median
15	1396938270	$72K	$295.61	4.7× median	Top 1%
16	1982007464	$61K	$57.98	0.9× median	Below Median
17	1912506312	$60K	$34.21	0.5× median	Below Median
18	1568739878	$51K	$237.70	3.8× median	Top 10%
19	1336341874	$48K	$72.16	1.2× median	Above Median
20	1538426952	$37K	$74.22	1.2× median	Above Median

Showing top 20 of 49 providers billing this code

Related Procedures

S5125Attendant care services, per 15 min$31.34B S5108Home care training to home care client, per 15 minutes$1.72B S5105Day care services, adult, per hour$1.66B S5121Attendant care services, in-home, per 15 min$227.6M S5110Home care training, family; per 15 min$162.4M

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