All 3,695 procedure codes billed by Medicaid providers in Illinois, ranked by total spending.
| # | Code | Description | Total Paid |
|---|---|---|---|
| 1 | T1015 | Clinic visit/encounter, all-inclusive | $3.27B |
| 2 | A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | $1.46B |
| 3 | A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | $963.67M |
| 4 | H0004 | Behavioral health counseling and therapy, per 15 minutes | $774.68M |
| 5 | 99214 | Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity | $719.98M |
| 6 | H2015 | Comprehensive community support services, per 15 minutes | $582.11M |
| 7 | 99213 | Office or other outpatient visit for the evaluation and management of an established patient, low complexity | $555.97M |
| 8 | A0425 | Ground mileage, per statute mile | $269.93M |
| 9 | H2000 | Comprehensive multidisciplinary evaluation | $267.51M |
| 10 | 99285 | Emergency department visit for the evaluation and management, high severity with immediate threat to life | $253.69M |
| 11 | T1016 | Case management, each 15 minutes | $222.08M |
| 12 | 99284 | Emergency department visit for the evaluation and management, high severity | $221.60M |
| 13 | 97110 | Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion | $218.39M |
| 14 | H2016 | Comprehensive community support services, per diem | $201.63M |
| 15 | D1120 | Prophylaxis - child | $191.41M |
| 16 | H0039 | Assertive community treatment, face-to-face, per 15 minutes | $190.63M |
| 17 | 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 | $179.97M |
| 18 | H2011 | Crisis intervention service, per 15 minutes | $148.79M |
| 19 | A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | $146.42M |
| 20 | H0005 | Alcohol and/or drug services; group counseling by a clinician | $145.08M |
| 21 | 99232 | Subsequent hospital care, per day, moderate complexity | $141.95M |
| 22 | D0120 | Periodic oral evaluation - established patient | $139.51M |
| 23 | S5130 | Homemaker service, nos; per 15 minutes | $138.97M |
| 24 | D0999 | Unspecified diagnostic procedure, by report | $133.61M |
| 25 | 90837 | Psychotherapy, 53 minutes with patient | $133.49M |
| 26 | 92508 | Group treatment of speech, language, voice, communication, and/or auditory processing disorder | $128.12M |
| 27 | 92507 | Treatment of speech, language, voice, communication, and/or auditory processing disorder | $123.76M |
| 28 | 99233 | Prolong inpt eval add15 m | $115.54M |
| 29 | D1351 | Sealant - per tooth | $110.91M |
| 30 | G0299 | Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes | $110.02M |
| 31 | 99283 | Emergency department visit for the evaluation and management, moderate severity | $106.30M |
| 32 | T1017 | Targeted case management, each 15 minutes | $103.70M |
| 33 | E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | $95.96M |
| 34 | J1428 | Injection, eteplirsen, 10 mg | $92.29M |
| 35 | A0434 | Specialty care transport (sct) | $91.54M |
| 36 | T4541 | Incontinence product, disposable underpad, large, each | $85.10M |
| 37 | A0120 | Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems | $80.17M |
| 38 | T1000 | Private duty / independent nursing service(s) - licensed, up to 15 minutes | $79.25M |
| 39 | S9484 | Crisis intervention mental health services, per hour | $74.88M |
| 40 | D8670 | Periodic orthodontic treatment visit | $73.07M |
| 41 | G0151 | Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes | $72.92M |
| 42 | D1208 | Topical application of fluoride, excluding varnish | $66.95M |
| 43 | 92014 | Ophthalmological services: medical examination and evaluation, comprehensive, established patient | $66.86M |
| 44 | T4527 | Adult sized disposable incontinence product, protective underwear/pull-on, large size, each | $66.16M |
| 45 | J1426 | Injection, casimersen, 10 mg | $65.64M |
| 46 | 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | $63.78M |
| 47 | T1021 | Home health aide or certified nurse assistant, per visit | $62.87M |
| 48 | 80307 | Drug test(s), presumptive, any number of drug classes; immunoassay | $61.51M |
| 49 | T2003 | Non-emergency transportation; encounter/trip | $61.17M |
| 50 | 96158 | $60.95M | |
| 51 | T1002 | Rn services, up to 15 minutes | $59.92M |
| 52 | 87591 | Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe | $59.67M |
| 53 | 87491 | Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe | $59.46M |
| 54 | U0004 | 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by cms-2020-01-r | $58.71M |
| 55 | D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | $57.36M |
| 56 | 0502F | $57.24M | |
| 57 | 70450 | Computed tomography, head or brain; without contrast material | $57.16M |
| 58 | 80053 | Comprehensive metabolic panel | $55.96M |
| 59 | T4535 | Disposable liner/shield/guard/pad/undergarment, for incontinence, each | $54.66M |
| 60 | T4528 | Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each | $52.46M |
| 61 | T2016 | Habilitation, residential, waiver; per diem | $51.90M |
| 62 | 99391 | Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) | $51.86M |
| 63 | T4526 | Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each | $51.78M |
| 64 | 90792 | Psychiatric diagnostic evaluation with medical services | $51.39M |
| 65 | 92004 | Ophthalmological services: medical examination and evaluation, comprehensive, new patient | $50.86M |
| 66 | 99204 | Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity | $49.89M |
| 67 | 90832 | Psychotherapy, 30 minutes with patient | $49.20M |
| 68 | 99291 | Critical care, evaluation and management of the critically ill patient, first 30-74 minutes | $47.56M |
| 69 | T1003 | Lpn/lvn services, up to 15 minutes | $46.95M |
| 70 | 99309 | Subsequent nursing facility care, per day, low to moderate complexity | $46.11M |
| 71 | 87389 | Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies | $45.97M |
| 72 | 99223 | Prolong inpt eval add15 m | $45.95M |
| 73 | D1206 | Topical application of fluoride varnish | $45.65M |
| 74 | 99393 | Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) | $44.04M |
| 75 | U0005 | 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, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2 | $43.35M |
| 76 | D4341 | $42.96M | |
| 77 | 92015 | Determination of refractive state | $42.75M |
| 78 | B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | $42.69M |
| 79 | 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 | $40.16M |
| 80 | 87637 | Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV | $39.90M |
| 81 | D7140 | Extraction, erupted tooth or exposed root | $39.84M |
| 82 | 84443 | Thyroid stimulating hormone (TSH) | $39.36M |
| 83 | 85025 | Blood count; complete (CBC), automated, and automated differential WBC count | $39.09M |
| 84 | 97530 | Therapeutic activities, direct patient contact, each 15 minutes | $37.55M |
| 85 | T1027 | Family training and counseling for child development, per 15 minutes | $37.42M |
| 86 | 99203 | Office or other outpatient visit for the evaluation and management of a new patient, low complexity | $36.63M |
| 87 | 99308 | Subsequent nursing facility care, per day, straightforward | $36.48M |
| 88 | H2010 | Comprehensive medication services, per 15 minutes | $36.44M |
| 89 | H2017 | Psychosocial rehabilitation services, per 15 minutes | $36.04M |
| 90 | G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | $35.98M |
| 91 | 92340 | Fitting of spectacles, except for aphakia; monofocal | $34.96M |
| 92 | D0150 | Comprehensive oral evaluation - new or established patient | $34.35M |
| 93 | 99394 | Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) | $34.04M |
| 94 | 99215 | Prolong outpt/office vis | $32.38M |
| 95 | H0002 | Behavioral health screening to determine eligibility for admission to treatment program | $32.33M |
| 96 | D0274 | Bitewings - four radiographic images | $32.05M |
| 97 | 87633 | Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets | $31.88M |
| 98 | 93010 | Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only | $31.38M |
| 99 | D7210 | Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth | $31.26M |
| 100 | 87636 | Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B | $30.49M |
| 101 | 87635 | Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe | $30.36M |
| 102 | D1110 | Prophylaxis - adult | $29.95M |
| 103 | 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 | $29.51M |
| 104 | E0466 | Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) | $29.05M |
| 105 | 87913 | $28.95M | |
| 106 | E0601 | Continuous positive airway pressure (cpap) device | $28.49M |
| 107 | 88305 | Level IV - Surgical pathology, gross and microscopic examination | $28.30M |
| 108 | 74177 | Computed tomography, abdomen and pelvis; with contrast material | $26.73M |
| 109 | 59409 | Vaginal delivery only (with or without episiotomy and/or forceps) | $25.45M |
| 110 | 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 | $25.02M |
| 111 | 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | $24.95M |
| 112 | 96164 | $24.72M | |
| 113 | T1040 | Medicaid certified community behavioral health clinic services, per diem | $24.49M |
| 114 | A0130 | Non-emergency transportation: wheelchair van | $24.16M |
| 115 | 90833 | Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) | $23.97M |
| 116 | 0241U | Neonatal screening for hereditary disorders, genomic sequence analysis panel | $23.88M |
| 117 | D2930 | Prefabricated stainless steel crown - primary tooth | $23.85M |
| 118 | 87811 | Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) | $23.41M |
| 119 | 87661 | Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe | $22.94M |
| 120 | 82306 | Vitamin D; 25 hydroxy, includes fraction(s), if performed | $22.31M |
| 121 | 80061 | Lipid panel | $22.08M |
| 122 | E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) | $21.63M |
| 123 | V2100 | Sphere, single vision, plano to plus or minus 4.00, per lens | $21.61M |
| 124 | D0220 | Intraoral - periapical first radiographic image | $21.59M |
| 125 | D2391 | Resin-based composite - one surface, posterior, primary or permanent | $20.99M |
| 126 | E0603 | Breast pump, electric (ac and/or dc), any type | $20.43M |
| 127 | E2402 | Negative pressure wound therapy electrical pump, stationary or portable | $20.40M |
| 128 | 67028 | Intravitreal injection of a pharmacologic agent | $20.09M |
| 129 | H0034 | Medication training and support, per 15 minutes | $20.08M |
| 130 | 87801 | Infectious agent detection by nucleic acid; amplified probe, multiple organisms | $19.88M |
| 131 | 99244 | Office or other outpatient consultation, moderate to high complexity | $19.77M |
| 132 | H2013 | Psychiatric health facility service, per diem | $19.71M |
| 133 | 93306 | Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete | $19.56M |
| 134 | S5199 | Personal care item, nos, each | $18.89M |
| 135 | S1040 | Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) | $18.58M |
| 136 | 90834 | Psychotherapy, 45 minutes with patient | $18.56M |
| 137 | 77067 | Screening mammography, bilateral, including computer-aided detection | $18.22M |
| 138 | A4353 | Intermittent urinary catheter, with insertion supplies | $17.94M |
| 139 | V5298 | Hearing aid, not otherwise classified | $17.93M |
| 140 | 96110 | Developmental screening, with scoring and documentation, per standardized instrument | $17.93M |
| 141 | J0178 | Injection, aflibercept, 1 mg | $17.66M |
| 142 | D2393 | Resin-based composite - three surfaces, posterior, primary or permanent | $17.31M |
| 143 | T4523 | Adult sized disposable incontinence product, brief/diaper, large, each | $17.28M |
| 144 | 99222 | Initial hospital care, per day, moderate complexity | $17.18M |
| 145 | T4544 | Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each | $17.05M |
| 146 | D0230 | Intraoral - periapical each additional radiographic image | $17.02M |
| 147 | A4554 | Disposable underpads, all sizes | $16.98M |
| 148 | A4927 | Gloves, non-sterile, per 100 | $16.92M |
| 149 | T4543 | Adult sized disposable incontinence product, protective brief/diaper, above extra large, each | $16.77M |
| 150 | G0152 | Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes | $16.66M |
| 151 | V2020 | Frames, purchases | $16.62M |
| 152 | T1502 | Administration of oral, intramuscular and/or subcutaneous medication by health care agency/professional, per visit | $16.42M |
| 153 | 81513 | $16.32M | |
| 154 | T4524 | Adult sized disposable incontinence product, brief/diaper, extra large, each | $16.29M |
| 155 | A4230 | Infusion set for external insulin pump, non needle cannula type | $16.21M |
| 156 | 97535 | Self-care/home management training, each 15 minutes | $16.10M |
| 157 | 76816 | Ultrasound, pregnant uterus, real time with image documentation, follow-up | $15.68M |
| 158 | B4160 | Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit | $15.57M |
| 159 | T4522 | Adult sized disposable incontinence product, brief/diaper, medium, each | $15.47M |
| 160 | 43239 | Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple | $15.25M |
| 161 | A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | $15.08M |
| 162 | 90791 | Psychiatric diagnostic evaluation | $15.08M |
| 163 | A4335 | Incontinence supply; miscellaneous | $14.83M |
| 164 | 97153 | Adaptive behavior treatment by protocol, administered by technician, each 15 minutes | $14.78M |
| 165 | 80048 | Basic metabolic panel (calcium, ionized) | $14.69M |
| 166 | 83036 | Hemoglobin; glycosylated (A1C) | $14.64M |
| 167 | 87651 | Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe | $14.59M |
| 168 | D0140 | Limited oral evaluation - problem focused | $14.57M |
| 169 | 99499 | $14.45M | |
| 170 | 90960 | End-stage renal disease related services monthly, for patients 20 years and older, with 4 or more face-to-face visits | $14.07M |
| 171 | E0784 | External ambulatory infusion pump, insulin | $14.02M |
| 172 | 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | $13.94M |
| 173 | 96112 | $13.86M | |
| 174 | 96127 | $13.20M | |
| 175 | 99239 | Hospital discharge day management, more than 30 minutes | $13.09M |
| 176 | 87426 | Infectious agent antigen detection, SARS-CoV-2 (COVID-19) | $13.02M |
| 177 | 99238 | Hospital discharge day management, 30 minutes or less | $13.01M |
| 178 | 87804 | Infectious agent antigen detection by immunoassay; Influenza, each type | $12.92M |
| 179 | A7030 | Full face mask used with positive airway pressure device, each | $12.59M |
| 180 | A6197 | Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing | $12.48M |
| 181 | 87086 | Culture, bacterial; quantitative colony count, urine | $12.35M |
| 182 | 83735 | $12.30M | |
| 183 | 71045 | Radiologic examination, chest; single view | $12.19M |
| 184 | 87502 | Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets | $12.18M |
| 185 | 0202U | Oncology (prostate), multianalyte, gene expression profiling | $12.09M |
| 186 | T4534 | Youth sized disposable incontinence product, protective underwear/pull-on, each | $12.06M |
| 187 | 80050 | General health panel | $12.00M |
| 188 | 99243 | $11.97M | |
| 189 | 66984 | Extracapsular cataract removal with insertion of intraocular lens prosthesis | $11.95M |
| 190 | 71046 | Radiologic examination, chest; 2 views | $11.90M |
| 191 | G0463 | Hospital outpatient clinic visit for assessment and management of a patient | $11.85M |
| 192 | 96152 | $11.74M | |
| 193 | A0431 | Ambulance service, conventional air services, transport, one way (rotary wing) | $11.47M |
| 194 | 99202 | Office or other outpatient visit for the evaluation and management of a new patient, straightforward | $11.43M |
| 195 | 99231 | Subsequent hospital care, per day, straightforward or low complexity | $11.38M |
| 196 | H0020 | Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) | $11.18M |
| 197 | B4154 | Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit | $11.12M |
| 198 | 93229 | $11.09M | |
| 199 | D0330 | Panoramic radiographic image | $11.07M |
| 200 | 92012 | Ophthalmological services: medical examination and evaluation, intermediate, established patient | $10.61M |