#439 of 11K

S5121

Attendant care services, in-home, per 15 min

Attendant care services, in-home, per 15 min is the #439 most-billed Medicaid procedure code, with $227.6M in payments across 414K claims from 2018–2024. The national median cost per claim is $111.06. Costs vary widely — the 90th percentile is $1,424.51 per claim, 12.8× the median.

Total Paid

$227.6M

0.02% of all spending

Total Claims

414K

Providers

Avg Cost/Claim

$549

National Cost Distribution

How much do providers bill per claim for S5121? Based on 68 providers billing this code nationally.

Median

$111.06

Average

$421.54

Std Dev

$711.95

Max

$3,463.40

Percentile Distribution (Cost per Claim)

p10

$35.48

p25

$46.43

Median

$111.06

p75

$300.45

p90

$1,424.51

p95

$1,700.77

p99

$3,163.42

50% of providers bill between $46.43 and $300.45 per claim for this code.

90% bill between $35.48 and $1,424.51.

Top 1% bill above $3,163.42.

About This Procedure

HCPCS code S5121 (Attendant care services, in-home, per 15 min) was billed by 70 providers across 414K claims, totaling $227.6M in Medicaid payments from 2018–2024. This code was used for 98K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$111.06

Providers Billing

National Spending

$227.6M

Avg/Median Ratio

3.80×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for S5121

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Fishing Point Health Care Llc Portsmouth, VA · General Practice	$152.6M	$1,302.95	11.7× median	Above 75th
2	Upper Mattaponi Indian Tribe Aylett, VA · Family Medicine	$48.2M	$1,422.57	12.8× median	Above 75th
3	1205459674	$4.4M	$396.84	3.6× median	Above 75th
4	1982012266	$4.2M	$1,155.87	10.4× median	Above 75th
5	Detroit Area Agency On Aging Detroit, MI · Case Management	$3.4M	$91.25	0.8× median	Below Median
6	1922185677	$2.0M	$595.15	5.4× median	Above 75th
7	1366524985	$1.7M	$674.73	6.1× median	Above 75th
8	Not Found Unknown, Unknown · Unknown	$1.1M	$109.05	1.0× median	Below Median
9	1821182585	$719K	$61.71	0.6× median	Below Median
10	Old Colony Elderly Services, Inc. Brockton, MA · Case Management	$714K	$40.33	0.4× median	Below Median
11	1518053347	$692K	$268.31	2.4× median	Above Median
12	1982741096	$671K	$76.69	0.7× median	Below Median
13	Area Agency On Aging 1-b Southfield, MI · Case Management	$573K	$80.59	0.7× median	Below Median
14	Elder Services Of Cape Cod And The Islands South Dennis, MA · Case Management	$542K	$22.80	0.2× median	Below Median
15	Guardiantrac. Llc Sturgis, MI · Community/Behavioral Health	$536K	$125.93	1.1× median	Above Median
16	1427487214	$520K	$46.18	0.4× median	Below Median
17	1669950101	$462K	$1,268.68	11.4× median	Above 75th
18	1922121169	$440K	$42.38	0.4× median	Below Median
19	1588054068	$388K	$1,770.89	15.9× median	Top 10%
20	1801038757	$297K	$94.49	0.9× median	Below Median

Showing top 20 of 70 providers billing this code

Related Procedures

S5125Attendant care services, per 15 min$31.34B S5130Homemaker service, NOS; per 15 min$4.89B S5126Attendant care services, per diem$4.44B S5131Homemaker service, NOS, per diem$172.8M S5111Home care training, family member, per session$139.4M

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