Medicaid Provider Spending

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

Billing Codes in Missouri

All 2,745 procedure codes billed by Medicaid providers in Missouri, ranked by total spending.

#CodeDescriptionTotal Paid
1 T1019 Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify services provided by home health aide or certified nurse assistant) $6.15B
2 T2016 Habilitation, residential, waiver; per diem $5.21B
3 T1040 Medicaid certified community behavioral health clinic services, per diem $3.90B
4 T2021 Day habilitation, waiver; per 15 minutes $904.96M
5 A0100 Non-emergency transportation; taxi $866.23M
6 G9012 Other specified case management service not elsewhere classified $645.02M
7 99213 Office or other outpatient visit for the evaluation and management of an established patient, low complexity $478.40M
8 99214 Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity $406.45M
9 X4011 State-specific procedure code $345.03M
10 T1000 Private duty / independent nursing service(s) - licensed, up to 15 minutes $338.90M
11 S0215 Non-emergency transportation; mileage, per mile $322.62M
12 99283 Emergency department visit for the evaluation and management, moderate severity $307.40M
13 S5150 Unskilled respite care, not hospice; per 15 minutes $279.17M
14 99284 Emergency department visit for the evaluation and management, high severity $277.50M
15 H0036 Community psychiatric supportive treatment, face-to-face, per 15 minutes $248.73M
16 W6110 $240.88M
17 99285 Emergency department visit for the evaluation and management, high severity with immediate threat to life $233.29M
18 A0130 Non-emergency transportation: wheelchair van $223.07M
19 S5136 Companion care, adult (e.g., iadl/adl); per diem $222.74M
20 H0037 Community psychiatric supportive treatment program, per diem $210.60M
21 G0463 Hospital outpatient clinic visit for assessment and management of a patient $209.21M
22 A0427 Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) $185.42M
23 A0425 Ground mileage, per statute mile $167.99M
24 T1001 Nursing assessment / evaluation $157.78M
25 Y7506 $154.83M
26 S5100 Day care services, adult; per 15 minutes $137.76M
27 H0018 Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem $136.24M
28 Y9504 $116.67M
29 85025 Blood count; complete (CBC), automated, and automated differential WBC count $115.43M
30 A0090 Non-emergency transportation, per mile - vehicle provided by individual (family member, self, neighbor) with vested interest $110.59M
31 A0429 Ambulance service, basic life support, emergency transport (bls-emergency) $108.49M
32 S5170 Home delivered meals, including preparation; per meal $97.85M
33 T1015 Clinic visit/encounter, all-inclusive $86.46M
34 80053 Comprehensive metabolic panel $86.23M
35 90999 Unlisted dialysis procedure, inpatient or outpatient $82.06M
36 X4003 $79.19M
37 A0120 Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems $70.23M
38 99232 Subsequent hospital care, per day, moderate complexity $70.15M
39 H2036 Alcohol and/or other drug treatment program, per diem $66.87M
40 90834 Psychotherapy, 45 minutes with patient $61.78M
41 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 $57.15M
42 T2029 Specialized medical equipment, not otherwise specified, waiver $56.89M
43 X4006 $50.42M
44 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder $49.37M
45 A0431 Ambulance service, conventional air services, transport, one way (rotary wing) $48.78M
46 A0080 Non-emergency transportation, per mile - vehicle provided by volunteer (individual or organization), with no vested interest $48.56M
47 H2017 Psychosocial rehabilitation services, per 15 minutes $46.80M
48 97530 Therapeutic activities, direct patient contact, each 15 minutes $46.70M
49 H2013 Psychiatric health facility service, per diem $46.09M
50 H2023 Supported employment, per 15 minutes $45.97M
51 H2015 Comprehensive community support services, per 15 minutes $45.02M
52 99391 Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) $44.81M
53 T2001 Non-emergency transportation; patient attendant/escort $44.46M
54 A0428 Ambulance service, basic life support, non-emergency transport, (bls) $44.27M
55 S5125 Attendant care services; per 15 minutes $42.37M
56 E1390 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate $40.83M
57 93005 Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report $40.33M
58 H0004 Behavioral health counseling and therapy, per 15 minutes $39.12M
59 J0256 Injection, alpha 1 proteinase inhibitor (human), not otherwise specified, 10 mg $38.59M
60 99392 Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) $38.15M
61 T1002 Rn services, up to 15 minutes $37.91M
62 81001 $35.21M
63 96374 Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance $34.57M
64 97153 Adaptive behavior treatment by protocol, administered by technician, each 15 minutes $32.88M
65 T2005 Non-emergency transportation; stretcher van $32.86M
66 H0031 Mental health assessment, by non-physician $32.61M
67 97155 Adaptive behavior treatment with protocol modification, administered by physician, each 15 minutes $32.09M
68 90837 Psychotherapy, 53 minutes with patient $32.00M
69 T2003 Non-emergency transportation; encounter/trip $30.43M
70 S5108 Home care training to home care client, per 15 minutes $30.19M
71 99233 Prolong inpt eval add15 m $29.40M
72 99203 Office or other outpatient visit for the evaluation and management of a new patient, low complexity $28.98M
73 J3490 Unclassified drugs $28.91M
74 Y7507 $28.56M
75 S5130 Homemaker service, nos; per 15 minutes $28.54M
76 99212 Office or other outpatient visit for the evaluation and management of an established patient, straightforward $27.50M
77 H2012 Behavioral health day treatment, per hour $26.79M
78 A0110 Non-emergency transportation and bus, intra or inter state carrier $26.16M
79 H0020 Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) $25.54M
80 H2016 Comprehensive community support services, per diem $25.52M
81 99215 Prolong outpt/office vis $25.17M
82 90853 Group psychotherapy (other than of a multiple-family group) $24.57M
83 99204 Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity $24.55M
84 99393 Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) $24.12M
85 B4035 Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape $23.67M
86 99308 Subsequent nursing facility care, per day, straightforward $23.15M
87 71045 Radiologic examination, chest; single view $21.95M
88 99282 Emergency department visit for the evaluation and management, low to moderate severity $21.92M
89 99309 Subsequent nursing facility care, per day, low to moderate complexity $20.97M
90 80307 Drug test(s), presumptive, any number of drug classes; immunoassay $20.52M
91 X4014 $20.42M
92 92014 Ophthalmological services: medical examination and evaluation, comprehensive, established patient $20.22M
93 H0005 Alcohol and/or drug services; group counseling by a clinician $19.75M
94 88305 Level IV - Surgical pathology, gross and microscopic examination $19.26M
95 74177 Computed tomography, abdomen and pelvis; with contrast material $18.91M
96 A0436 Rotary wing air mileage, per statute mile $18.71M
97 87804 Infectious agent antigen detection by immunoassay; Influenza, each type $18.41M
98 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 $18.10M
99 92004 Ophthalmological services: medical examination and evaluation, comprehensive, new patient $17.90M
100 71046 Radiologic examination, chest; 2 views $17.84M
101 76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up $17.60M
102 H2020 Therapeutic behavioral services, per diem $17.17M
103 70450 Computed tomography, head or brain; without contrast material $16.99M
104 99223 Prolong inpt eval add15 m $16.52M
105 D2392 Resin-based composite - two surfaces, posterior, primary or permanent $16.42M
106 80048 Basic metabolic panel (calcium, ionized) $16.35M
107 81025 $16.25M
108 T2025 Waiver services; not otherwise specified (nos) $15.88M
109 D1120 Prophylaxis - child $15.55M
110 90832 Psychotherapy, 30 minutes with patient $15.43M
111 D0120 Periodic oral evaluation - established patient $14.98M
112 0241U Neonatal screening for hereditary disorders, genomic sequence analysis panel $14.81M
113 87880 Infectious agent antigen detection by immunoassay; Streptococcus, group A $14.49M
114 T1028 Assessment of home, physical and family environment, to determine suitability to meet patient's medical needs $14.49M
115 T4527 Adult sized disposable incontinence product, protective underwear/pull-on, large size, each $14.36M
116 99291 Critical care, evaluation and management of the critically ill patient, first 30-74 minutes $14.33M
117 93306 Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete $14.26M
118 D7140 Extraction, erupted tooth or exposed root $14.25M
119 S5126 Attendant care services; per diem $13.96M
120 97110 Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion $13.91M
121 S0209 Wheelchair van, mileage, per mile $13.90M
122 E0431 Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing $13.48M
123 A0170 Transportation ancillary: parking fees, tolls, other $13.38M
124 81003 $13.16M
125 99509 Home visit for assistance with activities of daily living and personal care $12.96M
126 G0378 Hospital observation service, per hour $12.84M
127 A9999 Miscellaneous dme supply or accessory, not otherwise specified $12.79M
128 T4528 Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each $12.70M
129 85027 $12.67M
130 00170 Anesthesia for intraoral procedures, including biopsy $12.67M
131 A0888 Noncovered ambulance mileage, per mile (e.g., for miles traveled beyond closest appropriate facility) $12.61M
132 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple $12.57M
133 99394 Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) $12.20M
134 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 $12.09M
135 A0435 Fixed wing air mileage, per statute mile $11.96M
136 V2020 Frames, purchases $11.93M
137 87798 Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism $11.90M
138 G0176 Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more) $11.72M
139 A0426 Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) $11.55M
140 D7999 $11.33M
141 90792 Psychiatric diagnostic evaluation with medical services $11.32M
142 D1206 Topical application of fluoride varnish $11.20M
143 H0011 Alcohol and/or drug services; acute detoxification (residential addiction program inpatient) $11.18M
144 T2048 Behavioral health; long-term care residential (non-acute care in a residential treatment program where stay is typically longer than 30 days), with room and board, per diem $11.01M
145 D2930 Prefabricated stainless steel crown - primary tooth $10.78M
146 D1110 Prophylaxis - adult $10.75M
147 T4526 Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each $10.66M
148 92508 Group treatment of speech, language, voice, communication, and/or auditory processing disorder $10.47M
149 T2049 Non-emergency transportation; stretcher van, mileage; per mile $9.95M
150 H0001 Alcohol and/or drug assessment $9.94M
151 H0038 Self-help/peer services, per 15 minutes $9.82M
152 87502 Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets $9.71M
153 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 $9.68M
154 D0150 Comprehensive oral evaluation - new or established patient $9.45M
155 D0274 Bitewings - four radiographic images $9.31M
156 D2391 Resin-based composite - one surface, posterior, primary or permanent $9.31M
157 59025 Fetal non-stress test $9.15M
158 T4535 Disposable liner/shield/guard/pad/undergarment, for incontinence, each $9.15M
159 E0652 Pneumatic compressor, segmental home model with calibrated gradient pressure $9.15M
160 83690 $9.08M
161 H0025 Behavioral health prevention education service (delivery of services with target population to affect knowledge, attitude and/or behavior) $8.83M
162 99211 Office or other outpatient visit for the evaluation and management of an established patient, minimal severity $8.80M
163 93010 Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only $8.64M
164 D0330 Panoramic radiographic image $8.63M
165 99239 Hospital discharge day management, more than 30 minutes $8.60M
166 A0430 Ambulance service, conventional air services, transport, one way (fixed wing) $8.52M
167 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 $8.42M
168 90791 Psychiatric diagnostic evaluation $8.32M
169 69436 Tympanostomy (requiring insertion of ventilating tube), general anesthesia $8.29M
170 36415 Collection of venous blood by venipuncture $8.11M
171 99238 Hospital discharge day management, 30 minutes or less $8.10M
172 E0466 Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) $8.03M
173 T1025 Intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, mental and psychosocial impairments, per diem $7.86M
174 42820 Tonsillectomy and adenoidectomy; younger than age 12 $7.81M
175 T4534 Youth sized disposable incontinence product, protective underwear/pull-on, each $7.80M
176 H2010 Comprehensive medication services, per 15 minutes $7.74M
177 A0180 Non-emergency transportation: ancillary: lodging-recipient $7.63M
178 84484 $7.36M
179 90960 End-stage renal disease related services monthly, for patients 20 years and older, with 4 or more face-to-face visits $7.09M
180 11042 Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm $7.09M
181 T4541 Incontinence product, disposable underpad, large, each $7.06M
182 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 $7.01M
183 99469 Subsequent inpatient neonatal critical care, per day, 28 days or younger $6.98M
184 B4100 Food thickener, administered orally, per ounce $6.79M
185 D1351 Sealant - per tooth $6.73M
186 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 $6.64M
187 S9083 Global fee urgent care centers $6.60M
188 D8670 Periodic orthodontic treatment visit $6.57M
189 B4149 Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit $6.55M
190 T2002 Non-emergency transportation; per diem $6.53M
191 87400 $6.43M
192 99222 Initial hospital care, per day, moderate complexity $6.35M
193 0202U Oncology (prostate), multianalyte, gene expression profiling $6.34M
194 E1399 Durable medical equipment, miscellaneous $6.33M
195 93325 $6.30M
196 99472 Subsequent inpatient pediatric critical care, per day, 2-5 years $6.23M
197 87635 Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe $6.22M
198 87081 $6.20M
199 D0220 Intraoral - periapical first radiographic image $6.17M
200 D9999 Unspecified adjunctive procedure, by report $6.15M