Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers

Billing Codes in Hawaii

All 2,220 procedure codes billed by Medicaid providers in Hawaii, ranked by total spending.

#CodeDescriptionTotal Paid
1 99283 Emergency department visit for the evaluation and management, moderate severity $232.62M
2 99213 Office or other outpatient visit for the evaluation and management of an established patient, low complexity $193.81M
3 99284 Emergency department visit for the evaluation and management, high severity $179.47M
4 99214 Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity $162.45M
5 90999 Unlisted dialysis procedure, inpatient or outpatient $148.73M
6 99285 Emergency department visit for the evaluation and management, high severity with immediate threat to life $129.95M
7 J0887 Injection, epoetin beta, 1 microgram, (for esrd on dialysis) $96.86M
8 H2021 Community-based wrap-around services, per 15 minutes $82.86M
9 S9122 Home health aide or certified nurse assistant, providing care in the home; per hour $80.90M
10 T2016 Habilitation, residential, waiver; per diem $77.71M
11 S5130 Homemaker service, nos; per 15 minutes $64.46M
12 90837 Psychotherapy, 53 minutes with patient $51.12M
13 S5125 Attendant care services; per 15 minutes $50.06M
14 99282 Emergency department visit for the evaluation and management, low to moderate severity $46.73M
15 74177 Computed tomography, abdomen and pelvis; with contrast material $45.60M
16 J3490 Unclassified drugs $36.28M
17 90832 Psychotherapy, 30 minutes with patient $33.84M
18 D9999 Unspecified adjunctive procedure, by report $32.29M
19 J3590 Unclassified biologics $31.94M
20 A0427 Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) $30.15M
21 G0378 Hospital observation service, per hour $30.06M
22 S9123 Nursing care, in the home; by registered nurse, per hour (use for general nursing care only, not to be used when cpt codes 99500-99602 can be used) $25.09M
23 H2032 Activity therapy, per 15 minutes $23.08M
24 99212 Office or other outpatient visit for the evaluation and management of an established patient, straightforward $22.88M
25 T2022 Case management, per month $22.77M
26 S5140 Foster care, adult; per diem $22.30M
27 H2015 Comprehensive community support services, per 15 minutes $19.66M
28 D0140 Limited oral evaluation - problem focused $17.87M
29 T2021 Day habilitation, waiver; per 15 minutes $17.60M
30 H2019 Therapeutic behavioral services, per 15 minutes $17.57M
31 74176 Computed tomography, abdomen and pelvis; without contrast material $15.03M
32 S5170 Home delivered meals, including preparation; per meal $14.94M
33 D0120 Periodic oral evaluation - established patient $13.39M
34 D1120 Prophylaxis - child $13.06M
35 A0430 Ambulance service, conventional air services, transport, one way (fixed wing) $12.89M
36 Q4081 Injection, epoetin alfa, 100 units (for esrd on dialysis) $12.13M
37 97110 Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion $11.94M
38 99391 Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) $11.91M
39 80307 Drug test(s), presumptive, any number of drug classes; immunoassay $11.84M
40 99281 Emergency department visit for the evaluation and management, self-limited or minor $11.72M
41 99291 Critical care, evaluation and management of the critically ill patient, first 30-74 minutes $11.19M
42 77067 Screening mammography, bilateral, including computer-aided detection $11.02M
43 99509 Home visit for assistance with activities of daily living and personal care $10.73M
44 A0429 Ambulance service, basic life support, emergency transport (bls-emergency) $10.60M
45 99392 Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) $10.35M
46 80061 Lipid panel $9.81M
47 90834 Psychotherapy, 45 minutes with patient $9.62M
48 88305 Level IV - Surgical pathology, gross and microscopic examination $9.45M
49 T1002 Rn services, up to 15 minutes $9.31M
50 87491 Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe $9.30M
51 S5105 Day care services, center-based; services not included in program fee, per diem $9.21M
52 T2046 Hospice long term care, room and board only; per diem $9.13M
53 99233 Prolong inpt eval add15 m $9.03M
54 93306 Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete $8.98M
55 T2025 Waiver services; not otherwise specified (nos) $8.65M
56 H2011 Crisis intervention service, per 15 minutes $8.65M
57 84443 Thyroid stimulating hormone (TSH) $8.27M
58 G0467 Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit $8.21M
59 H0019 Behavioral health; long-term residential (non-medical, non-acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem $7.71M
60 92014 Ophthalmological services: medical examination and evaluation, comprehensive, established patient $7.58M
61 87591 Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe $7.49M
62 H0018 Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem $7.39M
63 H0020 Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) $6.66M
64 H2012 Behavioral health day treatment, per hour $6.61M
65 U0003 Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r $6.57M
66 99232 Subsequent hospital care, per day, moderate complexity $6.26M
67 99203 Office or other outpatient visit for the evaluation and management of a new patient, low complexity $6.14M
68 99393 Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) $5.96M
69 99215 Prolong outpt/office vis $5.89M
70 D2930 Prefabricated stainless steel crown - primary tooth $5.73M
71 G0483 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed $5.68M
72 85025 Blood count; complete (CBC), automated, and automated differential WBC count $5.58M
73 D1206 Topical application of fluoride varnish $5.29M
74 87635 Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe $5.11M
75 87502 Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets $5.03M
76 78815 Positron emission tomography (PET) for limited area imaging $4.91M
77 82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed $4.83M
78 90833 Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) $4.80M
79 83036 Hemoglobin; glycosylated (A1C) $4.79M
80 11042 Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm $4.62M
81 D0220 Intraoral - periapical first radiographic image $4.56M
82 80053 Comprehensive metabolic panel $4.43M
83 D2392 Resin-based composite - two surfaces, posterior, primary or permanent $4.39M
84 D0274 Bitewings - four radiographic images $4.32M
85 87389 Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies $4.30M
86 D0272 Bitewings - two radiographic images $4.25M
87 D9230 Inhalation of nitrous oxide / analgesia, anxiolysis $4.25M
88 45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) $4.22M
89 97140 Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) $4.16M
90 D7210 Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth $4.10M
91 G0481 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 8-14 drug class(es), including metabolite(s) if performed $4.04M
92 G0482 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 15-21 drug class(es), including metabolite(s) if performed $3.99M
93 99204 Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity $3.97M
94 G2025 Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only $3.86M
95 J0882 Injection, darbepoetin alfa, 1 microgram (for esrd on dialysis) $3.84M
96 G0463 Hospital outpatient clinic visit for assessment and management of a patient $3.81M
97 L8699 Prosthetic implant, not otherwise specified $3.78M
98 99442 $3.73M
99 90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine $3.71M
100 G0299 Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes $3.67M
101 76811 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed $3.65M
102 70450 Computed tomography, head or brain; without contrast material $3.64M
103 01967 Neuraxial labor analgesia/anesthesia for planned vaginal delivery $3.62M
104 H0015 Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education $3.60M
105 D1110 Prophylaxis - adult $3.57M
106 D0230 Intraoral - periapical each additional radiographic image $3.56M
107 45380 Colonoscopy, flexible; with biopsy, single or multiple $3.55M
108 D7240 Removal of impacted tooth - completely bony $3.49M
109 87624 Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types $3.46M
110 97530 Therapeutic activities, direct patient contact, each 15 minutes $3.44M
111 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple $3.44M
112 H0046 Mental health services, not otherwise specified $3.42M
113 86003 $3.37M
114 71046 Radiologic examination, chest; 2 views $3.27M
115 E0601 Continuous positive airway pressure (cpap) device $3.25M
116 92012 Ophthalmological services: medical examination and evaluation, intermediate, established patient $3.21M
117 70553 Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences $3.05M
118 D0330 Panoramic radiographic image $3.05M
119 41899 Unlisted procedure, dentoalveolar structures $3.01M
120 99223 Prolong inpt eval add15 m $2.97M
121 J7307 Etonogestrel (contraceptive) implant system, including implant and supplies $2.94M
122 87481 $2.88M
123 99394 Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) $2.86M
124 A0425 Ground mileage, per statute mile $2.82M
125 J0585 Injection, onabotulinumtoxina, 1 unit $2.81M
126 H0032 Mental health service plan development by non-physician $2.77M
127 92250 $2.72M
128 90960 End-stage renal disease related services monthly, for patients 20 years and older, with 4 or more face-to-face visits $2.67M
129 S0215 Non-emergency transportation; mileage, per mile $2.66M
130 G0480 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed $2.65M
131 A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply $2.64M
132 99441 $2.63M
133 D1351 Sealant - per tooth $2.62M
134 S9342 Home therapy; enteral nutrition via pump; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem $2.61M
135 11045 $2.61M
136 80050 General health panel $2.55M
137 J9271 Injection, pembrolizumab, 1 mg $2.52M
138 S9088 Services provided in an urgent care center (list in addition to code for service) $2.51M
139 V2020 Frames, purchases $2.47M
140 S5102 Day care services, adult; per diem $2.44M
141 J1756 Injection, iron sucrose, 1 mg $2.43M
142 90853 Group psychotherapy (other than of a multiple-family group) $2.42M
143 98968 $2.41M
144 E1390 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate $2.38M
145 D1208 Topical application of fluoride, excluding varnish $2.36M
146 H0044 Supported housing, per month $2.34M
147 G0151 Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes $2.23M
148 78452 Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress $2.23M
149 J7298 Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg $2.22M
150 T4527 Adult sized disposable incontinence product, protective underwear/pull-on, large size, each $2.08M
151 66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis $2.07M
152 59025 Fetal non-stress test $2.01M
153 92015 Determination of refractive state $2.00M
154 B4161 Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit $1.93M
155 76815 Ultrasound, pregnant uterus, real time with image documentation, limited $1.93M
156 76805 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation $1.89M
157 87651 Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe $1.88M
158 92004 Ophthalmological services: medical examination and evaluation, comprehensive, new patient $1.87M
159 D7140 Extraction, erupted tooth or exposed root $1.86M
160 86803 $1.86M
161 36415 Collection of venous blood by venipuncture $1.85M
162 76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up $1.83M
163 T1015 Clinic visit/encounter, all-inclusive $1.83M
164 99601 $1.81M
165 90791 Psychiatric diagnostic evaluation $1.80M
166 0241U Neonatal screening for hereditary disorders, genomic sequence analysis panel $1.80M
167 90792 Psychiatric diagnostic evaluation with medical services $1.76M
168 96361 Intravenous infusion, hydration; each additional hour $1.75M
169 D3330 Endodontic therapy, molar tooth (excluding final restoration) $1.69M
170 97112 Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination $1.69M
171 T2020 Day habilitation, waiver; per diem $1.68M
172 T4526 Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each $1.67M
173 D2391 Resin-based composite - one surface, posterior, primary or permanent $1.67M
174 A9274 External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories $1.61M
175 83970 $1.60M
176 98967 $1.60M
177 A0428 Ambulance service, basic life support, non-emergency transport, (bls) $1.59M
178 97153 Adaptive behavior treatment by protocol, administered by technician, each 15 minutes $1.57M
179 S9126 Hospice care, in the home, per diem $1.57M
180 G0470 Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a mental health visit $1.56M
181 A7030 Full face mask used with positive airway pressure device, each $1.56M
182 96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour $1.55M
183 70551 Magnetic resonance imaging, brain; without contrast material $1.54M
184 D2150 Silver amalgam - two surfaces, primary or permanent $1.53M
185 0002A $1.52M
186 95811 $1.52M
187 90472 Immunization administration, each additional vaccine (list separately) $1.49M
188 A0130 Non-emergency transportation: wheelchair van $1.49M
189 0001A $1.47M
190 87186 $1.47M
191 D0150 Comprehensive oral evaluation - new or established patient $1.47M
192 84153 $1.46M
193 E2402 Negative pressure wound therapy electrical pump, stationary or portable $1.46M
194 76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete $1.44M
195 71045 Radiologic examination, chest; single view $1.44M
196 96413 Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance $1.42M
197 87633 Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets $1.41M
198 99202 Office or other outpatient visit for the evaluation and management of a new patient, straightforward $1.40M
199 76700 Ultrasound, abdominal, real time with image documentation; complete $1.39M
200 A0435 Fixed wing air mileage, per statute mile $1.37M