#726 of 11K

S9126

Hospice care, in the home, per diem

Hospice care, in the home, per diem is the #726 most-billed Medicaid procedure code, with $95.2M in payments across 148K claims from 2018–2024. The national median cost per claim is $438.57. Costs vary widely — the 90th percentile is $3,405.78 per claim, 7.8× the median.

Total Paid

$95.2M

0.01% of all spending

Total Claims

148K

Providers

Avg Cost/Claim

$641

National Cost Distribution

How much do providers bill per claim for S9126? Based on 43 providers billing this code nationally.

Median

$438.57

Average

$1,363.55

Std Dev

$1,395.40

Max

$4,372.53

Percentile Distribution (Cost per Claim)

p10

$87.26

p25

$167.44

Median

$438.57

p75

$2,678.13

p90

$3,405.78

p95

$3,557.78

p99

$4,213.07

50% of providers bill between $167.44 and $2,678.13 per claim for this code.

90% bill between $87.26 and $3,405.78.

Top 1% bill above $4,213.07.

About This Procedure

HCPCS code S9126 (Hospice care, in the home, per diem) was billed by 44 providers across 148K claims, totaling $95.2M in Medicaid payments from 2018–2024. This code was used for 24K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$438.57

Providers Billing

National Spending

$95.2M

Avg/Median Ratio

3.11×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for S9126

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Hospice Care Of South Carolina, Llc Spartanburg, SC · Hospice Care, Community Based	$30.6M	$1,846.59	4.2× median	Above Median
2	1235794264	$19.9M	$2,554.43	5.8× median	Above Median
3	1033309877	$8.9M	$2,385.97	5.4× median	Above Median
4	1609868645	$5.7M	$1,821.65	4.2× median	Above Median
5	Visiting Nurse Service Of New York Hospice Care New York, NY · Hospice Care Community Based	$5.5M	$263.18	0.6× median	Below Median
6	1437160058	$5.1M	$2,795.88	6.4× median	Above 75th
7	1932108776	$2.9M	$78.28	0.2× median	Below Median
8	1407140387	$2.4M	$2,733.04	6.2× median	Above 75th
9	1043289333	$2.3M	$2,623.22	6.0× median	Above Median
10	1194745190	$1.7M	$236.29	0.5× median	Below Median
11	1184932345	$1.6M	$185.07	0.4× median	Below Median
12	1538174263	$1.3M	$155.06	0.4× median	Below Median
13	1205049558	$963K	$357.30	0.8× median	Below Median
14	1144328881	$896K	$1,964.50	4.5× median	Above Median
15	1306253794	$774K	$86.57	0.2× median	Below Median
16	1861445835	$544K	$137.07	0.3× median	Below Median
17	1003864869	$469K	$241.47	0.6× median	Below Median
18	1376717108	$303K	$2,860.76	6.5× median	Above 75th
19	1629540901	$302K	$4,372.53	10.0× median	Top 1%
20	1134126071	$294K	$173.64	0.4× median	Below Median

Showing top 20 of 44 providers billing this code

Related Procedures

S9124Nursing care, in the home; per hour$4.96B S9123Nursing care, in the home, by RN, per 15 minutes$2.34B S9122Home health aide or certified nurse, per hour$1.43B S9131Physical therapy, in the home, per diem$215.4M S9125Respite care, in the home, per diem$141.9M

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