#1255 of 11K

S5116

HCPCS Procedure Code

HCPCS code S5116 is the #1,255 most-billed Medicaid procedure code, with $30.8M in payments across 401K claims from 2018–2024. The national median cost per claim is $30.00. Costs vary widely — the 90th percentile is $212.49 per claim, 7.1× the median.

Total Paid

$30.8M

0.00% of all spending

Total Claims

401K

Providers

143

Avg Cost/Claim

$77

National Cost Distribution

How much do providers bill per claim for S5116? Based on 143 providers billing this code nationally.

Median

$30.00

Average

$68.62

Std Dev

$85.40

Max

$388.16

Percentile Distribution (Cost per Claim)

p10

$17.79

p25

$20.59

Median

$30.00

p75

$67.62

p90

$212.49

p95

$298.78

p99

$356.65

50% of providers bill between $20.59 and $67.62 per claim for this code.

90% bill between $17.79 and $212.49.

Top 1% bill above $356.65.

About This Procedure

HCPCS code S5116 was billed by 143 providers across 401K claims, totaling $30.8M in Medicaid payments from 2018–2024. This code was used for 353K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$30.00

Providers Billing

143

National Spending

$30.8M

Avg/Median Ratio

2.29×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for S5116

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1033271895	$19.5M	$287.82	9.6× median	Top 10%
2	1619477841	$2.9M	$29.61	1.0× median	Below Median
3	1720466659	$2.9M	$24.28	0.8× median	Below Median
4	1356414015	$822K	$124.91	4.2× median	Above 75th
5	1891116265	$479K	$80.13	2.7× median	Above 75th
6	1598131674	$314K	$31.45	1.0× median	Above Median
7	1306372354	$248K	$56.35	1.9× median	Above Median
8	1811255359	$243K	$24.41	0.8× median	Below Median
9	Macomb County Community Mental Health Clinton Twp, MI · Clinic/Center Mental Health (Including Community Mental Health Center)	$192K	$193.16	6.4× median	Above 75th
10	1942743810	$184K	$39.86	1.3× median	Above Median
11	1972544070	$163K	$304.59	10.2× median	Top 10%
12	Bayada Home Health Care, Inc. Monroeville, PA · Home Health	$121K	$192.25	6.4× median	Above 75th
13	Bayada Home Health Care, Inc. Blairsville, PA · Home Health	$119K	$215.58	7.2× median	Top 10%
14	1194182790	$117K	$25.67	0.9× median	Below Median
15	1366736589	$111K	$304.45	10.1× median	Top 10%
16	1578913455	$107K	$27.39	0.9× median	Below Median
17	1215234786	$104K	$19.29	0.6× median	Below Median
18	1588177323	$90K	$20.93	0.7× median	Below Median
19	1487014932	$87K	$102.90	3.4× median	Above 75th
20	1285174466	$82K	$74.64	2.5× median	Above 75th

Showing top 20 of 143 providers billing this code

Related Procedures

S5125Attendant care services, per 15 min$31.34B S5126Attendant care services, per diem$4.44B S5108Home care training to home care client, per 15 minutes$1.72B S5121Attendant care services, in-home, per 15 min$227.6M S5110Home care training, family; per 15 min$162.4M

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