Medicaid Provider Spending

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

Billing Codes in Montana

All 1,870 procedure codes billed by Medicaid providers in Montana, ranked by total spending.

#CodeDescriptionTotal Paid
1 S5126 Attendant care services; per diem $1.78B
2 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) $553.05M
3 T2017 Habilitation, residential, waiver; 15 minutes $276.94M
4 S5150 Unskilled respite care, not hospice; per 15 minutes $234.03M
5 90837 Psychotherapy, 53 minutes with patient $172.43M
6 H0036 Community psychiatric supportive treatment, face-to-face, per 15 minutes $147.10M
7 99214 Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity $119.56M
8 T2021 Day habilitation, waiver; per 15 minutes $118.11M
9 99213 Office or other outpatient visit for the evaluation and management of an established patient, low complexity $102.76M
10 S5145 Foster care, therapeutic, child; per diem $98.50M
11 S5136 Companion care, adult (e.g., iadl/adl); per diem $93.95M
12 T2031 Assisted living; waiver, per diem $89.31M
13 T2013 Habilitation, educational, waiver; per hour $87.63M
14 T1016 Case management, each 15 minutes $73.78M
15 H0018 Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem $61.71M
16 S5102 Day care services, adult; per diem $57.43M
17 H0040 Assertive community treatment program, per diem $54.99M
18 T2022 Case management, per month $54.70M
19 97530 Therapeutic activities, direct patient contact, each 15 minutes $40.61M
20 99284 Emergency department visit for the evaluation and management, high severity $35.33M
21 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder $32.97M
22 T2016 Habilitation, residential, waiver; per diem $32.14M
23 H2012 Behavioral health day treatment, per hour $30.22M
24 99285 Emergency department visit for the evaluation and management, high severity with immediate threat to life $28.97M
25 H2019 Therapeutic behavioral services, per 15 minutes $27.36M
26 99283 Emergency department visit for the evaluation and management, moderate severity $24.76M
27 D2392 Resin-based composite - two surfaces, posterior, primary or permanent $22.72M
28 T2032 Residential care, not otherwise specified (nos), waiver; per month $20.93M
29 H2020 Therapeutic behavioral services, per diem $20.60M
30 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 $18.66M
31 92014 Ophthalmological services: medical examination and evaluation, comprehensive, established patient $16.08M
32 D1120 Prophylaxis - child $15.88M
33 G2021 Health care practitioners rendering treatment in place (tip) $15.58M
34 A0429 Ambulance service, basic life support, emergency transport (bls-emergency) $15.34M
35 T1002 Rn services, up to 15 minutes $15.16M
36 D0120 Periodic oral evaluation - established patient $15.10M
37 E1390 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate $14.11M
38 D1206 Topical application of fluoride varnish $14.07M
39 D8670 Periodic orthodontic treatment visit $13.41M
40 99215 Prolong outpt/office vis $13.40M
41 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 $13.04M
42 92004 Ophthalmological services: medical examination and evaluation, comprehensive, new patient $11.90M
43 D1110 Prophylaxis - adult $11.88M
44 H0032 Mental health service plan development by non-physician $11.54M
45 D2930 Prefabricated stainless steel crown - primary tooth $11.35M
46 D9223 Deep sedation/general anesthesia - each subsequent 15 minute increment $11.29M
47 H0037 Community psychiatric supportive treatment program, per diem $10.43M
48 S5100 Day care services, adult; per 15 minutes $10.03M
49 S9485 Crisis intervention mental health services, per diem $9.83M
50 H0016 Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting) $9.65M
51 H2025 Ongoing support to maintain employment, per 15 minutes $9.15M
52 90834 Psychotherapy, 45 minutes with patient $8.83M
53 D7210 Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth $8.39M
54 S5140 Foster care, adult; per diem $8.36M
55 S5135 Companion care, adult (e.g., iadl/adl); per 15 minutes $8.27M
56 A0427 Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) $7.85M
57 D7240 Removal of impacted tooth - completely bony $7.75M
58 99392 Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) $7.71M
59 99391 Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) $7.60M
60 A0430 Ambulance service, conventional air services, transport, one way (fixed wing) $7.49M
61 99232 Subsequent hospital care, per day, moderate complexity $7.47M
62 T1003 Lpn/lvn services, up to 15 minutes $7.41M
63 88305 Level IV - Surgical pathology, gross and microscopic examination $7.12M
64 99203 Office or other outpatient visit for the evaluation and management of a new patient, low complexity $7.07M
65 97110 Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion $7.07M
66 90791 Psychiatric diagnostic evaluation $7.01M
67 41899 Unlisted procedure, dentoalveolar structures $6.72M
68 D0367 $6.55M
69 90832 Psychotherapy, 30 minutes with patient $6.49M
70 D1351 Sealant - per tooth $6.38M
71 99204 Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity $6.32M
72 74177 Computed tomography, abdomen and pelvis; with contrast material $6.23M
73 D1310 $6.22M
74 H0038 Self-help/peer services, per 15 minutes $6.00M
75 T2033 Residential care, not otherwise specified (nos), waiver; per diem $5.89M
76 A0435 Fixed wing air mileage, per statute mile $5.74M
77 D9999 Unspecified adjunctive procedure, by report $5.60M
78 90833 Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) $5.56M
79 97112 Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination $5.37M
80 90853 Group psychotherapy (other than of a multiple-family group) $5.36M
81 D2391 Resin-based composite - one surface, posterior, primary or permanent $5.33M
82 D0330 Panoramic radiographic image $5.21M
83 H0012 Alcohol and/or drug services; sub-acute detoxification (residential addiction program outpatient) $5.16M
84 99233 Prolong inpt eval add15 m $4.89M
85 90460 Immunization administration through 18 years of age via any route, first or only component $4.85M
86 D7140 Extraction, erupted tooth or exposed root $4.84M
87 D0274 Bitewings - four radiographic images $4.78M
88 92340 Fitting of spectacles, except for aphakia; monofocal $4.70M
89 D0272 Bitewings - two radiographic images $4.68M
90 92015 Determination of refractive state $4.67M
91 T2002 Non-emergency transportation; per diem $4.53M
92 D8080 Comprehensive orthodontic treatment of the adolescent dentition $4.36M
93 D0150 Comprehensive oral evaluation - new or established patient $3.88M
94 D0140 Limited oral evaluation - problem focused $3.87M
95 90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine $3.75M
96 D9222 $3.62M
97 D1330 $3.61M
98 99282 Emergency department visit for the evaluation and management, low to moderate severity $3.56M
99 76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up $3.55M
100 99393 Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) $3.45M
101 93306 Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete $3.38M
102 97140 Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) $3.33M
103 D2393 Resin-based composite - three surfaces, posterior, primary or permanent $3.28M
104 T4535 Disposable liner/shield/guard/pad/undergarment, for incontinence, each $3.23M
105 00170 Anesthesia for intraoral procedures, including biopsy $3.19M
106 T2001 Non-emergency transportation; patient attendant/escort $3.17M
107 92508 Group treatment of speech, language, voice, communication, and/or auditory processing disorder $3.08M
108 90792 Psychiatric diagnostic evaluation with medical services $3.05M
109 T2003 Non-emergency transportation; encounter/trip $3.04M
110 S5125 Attendant care services; per 15 minutes $3.03M
111 E0601 Continuous positive airway pressure (cpap) device $2.89M
112 D9310 $2.89M
113 98941 Chiropractic manipulative treatment; spinal, 3-4 regions $2.84M
114 70450 Computed tomography, head or brain; without contrast material $2.82M
115 D2740 Crown - porcelain/ceramic $2.78M
116 A4927 Gloves, non-sterile, per 100 $2.78M
117 A0382 Bls routine disposable supplies $2.73M
118 H2034 Alcohol and/or drug abuse halfway house services, per diem $2.71M
119 99205 Prolong outpt/office vis $2.71M
120 42820 Tonsillectomy and adenoidectomy; younger than age 12 $2.71M
121 80307 Drug test(s), presumptive, any number of drug classes; immunoassay $2.70M
122 95810 Polysomnography; sleep staging with 4 or more additional parameters $2.61M
123 D9243 $2.55M
124 Q3014 Telehealth originating site facility fee $2.52M
125 D9230 Inhalation of nitrous oxide / analgesia, anxiolysis $2.51M
126 99212 Office or other outpatient visit for the evaluation and management of an established patient, straightforward $2.47M
127 H0010 Alcohol and/or drug services; sub-acute detoxification (residential addiction program inpatient) $2.46M
128 A0425 Ground mileage, per statute mile $2.37M
129 A0431 Ambulance service, conventional air services, transport, one way (rotary wing) $2.31M
130 D9248 $2.26M
131 T2028 Specialized supply, not otherwise specified, waiver $2.22M
132 90847 Family psychotherapy with the patient present, 50 minutes $2.21M
133 T4527 Adult sized disposable incontinence product, protective underwear/pull-on, large size, each $2.19M
134 99223 Prolong inpt eval add15 m $2.18M
135 A0398 Als routine disposable supplies $2.18M
136 82075 $2.14M
137 99291 Critical care, evaluation and management of the critically ill patient, first 30-74 minutes $2.12M
138 D0220 Intraoral - periapical first radiographic image $2.09M
139 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 $2.09M
140 D0603 $2.06M
141 A0380 Bls mileage (per mile) $1.92M
142 A7030 Full face mask used with positive airway pressure device, each $1.87M
143 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple $1.86M
144 S9484 Crisis intervention mental health services, per hour $1.86M
145 D7230 $1.83M
146 T4528 Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each $1.80M
147 90472 Immunization administration, each additional vaccine (list separately) $1.80M
148 T4526 Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each $1.80M
149 H0046 Mental health services, not otherwise specified $1.77M
150 B4035 Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape $1.72M
151 76811 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed $1.70M
152 H2015 Comprehensive community support services, per 15 minutes $1.64M
153 E0431 Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing $1.63M
154 A0436 Rotary wing air mileage, per statute mile $1.62M
155 D4341 $1.60M
156 E2402 Negative pressure wound therapy electrical pump, stationary or portable $1.58M
157 97153 Adaptive behavior treatment by protocol, administered by technician, each 15 minutes $1.58M
158 G0378 Hospital observation service, per hour $1.57M
159 95811 $1.56M
160 A4604 Tubing with integrated heating element for use with positive airway pressure device $1.54M
161 71046 Radiologic examination, chest; 2 views $1.49M
162 93010 Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only $1.49M
163 D9920 $1.46M
164 D9630 $1.45M
165 D0350 $1.45M
166 99394 Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) $1.45M
167 D0425 $1.37M
168 80053 Comprehensive metabolic panel $1.36M
169 A7031 Face mask interface, replacement for full face mask, each $1.35M
170 S5130 Homemaker service, nos; per 15 minutes $1.29M
171 99222 Initial hospital care, per day, moderate complexity $1.28M
172 99239 Hospital discharge day management, more than 30 minutes $1.25M
173 71045 Radiologic examination, chest; single view $1.24M
174 90846 Family psychotherapy without the patient present, 50 minutes $1.24M
175 D0145 Oral evaluation for a patient under three years of age $1.24M
176 85025 Blood count; complete (CBC), automated, and automated differential WBC count $1.21M
177 T4537 Incontinence product, protective underpad, reusable, bed size, each $1.18M
178 D9612 $1.15M
179 77067 Screening mammography, bilateral, including computer-aided detection $1.15M
180 S9480 Intensive outpatient psychiatric services, per diem $1.14M
181 G0330 Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an operating room $1.12M
182 H2032 Activity therapy, per 15 minutes $1.12M
183 87635 Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe $1.09M
184 99202 Office or other outpatient visit for the evaluation and management of a new patient, straightforward $1.07M
185 S4993 Contraceptive pills for birth control $1.06M
186 92250 $1.06M
187 A0394 Als specialized service disposable supplies; iv drug therapy $1.06M
188 70553 Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences $1.02M
189 90839 $1.02M
190 D1354 $1.02M
191 D2751 Crown - porcelain fused to predominantly base metal $1.02M
192 D2929 $1.01M
193 69436 Tympanostomy (requiring insertion of ventilating tube), general anesthesia $1.01M
194 66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis $999K
195 D9239 $994K
196 88307 $989K
197 T4541 Incontinence product, disposable underpad, large, each $982K
198 A7034 Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap $978K
199 93303 Transthoracic echocardiography for congenital cardiac anomalies, follow-up or limited study $976K
200 D0240 $972K