#1306 of 11K

T2038

Community transition, waiver; per service

Community transition, waiver; per service is the #1,306 most-billed Medicaid procedure code, with $28.1M in payments across 149K claims from 2018–2024. The national median cost per claim is $531.12. Costs vary widely — the 90th percentile is $1,542.32 per claim, 2.9× the median.

Total Paid

$28.1M

0.00% of all spending

Total Claims

149K

Providers

Avg Cost/Claim

$188

National Cost Distribution

How much do providers bill per claim for T2038? Based on 62 providers billing this code nationally.

Median

$531.12

Average

$707.52

Std Dev

$626.35

Max

$2,714.29

Percentile Distribution (Cost per Claim)

p10

$41.03

p25

$153.09

Median

$531.12

p75

$1,013.48

p90

$1,542.32

p95

$1,871.39

p99

$2,434.17

50% of providers bill between $153.09 and $1,013.48 per claim for this code.

90% bill between $41.03 and $1,542.32.

Top 1% bill above $2,434.17.

About This Procedure

HCPCS code T2038 (Community transition, waiver; per service) was billed by 95 providers across 149K claims, totaling $28.1M in Medicaid payments from 2018–2024. This code was used for 88K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$531.12

Providers Billing

National Spending

$28.1M

Avg/Median Ratio

1.33×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for T2038

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Massachusetts Rehabilitation Commission Worcester, MA · Community/Behavioral Health	$14.0M	$2,255.08	4.2× median	Top 10%
2	1255730222	$2.4M	$248.03	0.5× median	Below Median
3	Master-care Inc Folsom, CA · Supports Brokerage	$2.3M	$447.64	0.8× median	Below Median
4	1083730899	$1.4M	$697.20	1.3× median	Above Median
5	1447652227	$980K	$1,033.28	1.9× median	Above 75th
6	1265532410	$755K	$916.81	1.7× median	Above Median
7	1003355405	$593K	$1,435.35	2.7× median	Above 75th
8	1902279789	$539K	$1,729.12	3.3× median	Top 10%
9	James Kukwa Saint Paul, MN · Social Worker	$524K	$839.12	1.6× median	Above Median
10	1316319197	$479K	$691.75	1.3× median	Above Median
11	A994520200	$445K	$930.26	1.8× median	Above Median
12	1326579723	$328K	$196.81	0.4× median	Below Median
13	1902881188	$313K	$1,158.76	2.2× median	Above 75th
14	1518415736	$282K	$847.08	1.6× median	Above Median
15	1881645067	$277K	$852.45	1.6× median	Above Median
16	Cns Healthcare Novi, MI · Psychiatry & Neurology Psychiatry	$202K	$573.11	1.1× median	Above Median
17	1811193063	$202K	$532.68	1.0× median	Above Median
18	1821454398	$171K	$2,714.29	5.1× median	Top 1%
19	1619045176	$149K	$783.39	1.5× median	Above Median
20	1841262839	$116K	$40.86	0.1× median	Below Median

Showing top 20 of 95 providers billing this code

Related Procedures

T2033Residential care, NOS; per diem$7.42B T2031Waiver services, not otherwise specified$4.65B T2046Habilitation, residential, waiver; per month$4.19B T2030Supported employment, job coaching, waiver, per diem$1.02B T2048Behavioral health; long-term residential, per diem$958.7M

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