Medicaid Provider Spending

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

Billing Codes in New York

All 5,634 procedure codes billed by Medicaid providers in New York, 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) $74.59B
2 99213 Office or other outpatient visit for the evaluation and management of an established patient, low complexity $6.09B
3 T1020 Personal care services, per diem, 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) $4.63B
4 99214 Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity $3.03B
5 S5126 Attendant care services; per diem $2.39B
6 G9005 Coordinated care fee, risk adjusted maintenance $2.06B
7 90834 Psychotherapy, 45 minutes with patient $1.96B
8 90832 Psychotherapy, 30 minutes with patient $1.62B
9 S5105 Day care services, center-based; services not included in program fee, per diem $1.45B
10 99284 Emergency department visit for the evaluation and management, high severity $1.05B
11 99283 Emergency department visit for the evaluation and management, moderate severity $1.02B
12 T2022 Case management, per month $962.31M
13 S5150 Unskilled respite care, not hospice; per 15 minutes $939.78M
14 H2015 Comprehensive community support services, per 15 minutes $911.70M
15 S5102 Day care services, adult; per diem $877.00M
16 99212 Office or other outpatient visit for the evaluation and management of an established patient, straightforward $834.21M
17 H2014 Skills training and development, per 15 minutes $731.75M
18 97530 Therapeutic activities, direct patient contact, each 15 minutes $664.08M
19 A0429 Ambulance service, basic life support, emergency transport (bls-emergency) $661.20M
20 T1040 Medicaid certified community behavioral health clinic services, per diem $644.16M
21 99203 Office or other outpatient visit for the evaluation and management of a new patient, low complexity $639.15M
22 97110 Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion $626.89M
23 99285 Emergency department visit for the evaluation and management, high severity with immediate threat to life $595.38M
24 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder $585.50M
25 H0020 Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) $543.14M
26 H0040 Assertive community treatment program, per diem $481.26M
27 H2036 Alcohol and/or other drug treatment program, per diem $478.91M
28 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 $474.14M
29 90791 Psychiatric diagnostic evaluation $439.12M
30 G2067 Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a medicare-enrolled opioid treatment program) $415.31M
31 S9124 Nursing care, in the home; by licensed practical nurse, per hour $406.84M
32 H2016 Comprehensive community support services, per diem $393.74M
33 90837 Psychotherapy, 53 minutes with patient $386.51M
34 99204 Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity $375.47M
35 H2021 Community-based wrap-around services, per 15 minutes $362.57M
36 S5125 Attendant care services; per 15 minutes $346.06M
37 S9083 Global fee urgent care centers $339.04M
38 A0427 Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) $334.03M
39 A0100 Non-emergency transportation; taxi $327.80M
40 D0120 Periodic oral evaluation - established patient $317.83M
41 D1110 Prophylaxis - adult $309.93M
42 99282 Emergency department visit for the evaluation and management, low to moderate severity $306.07M
43 A0130 Non-emergency transportation: wheelchair van $299.72M
44 H2019 Therapeutic behavioral services, per 15 minutes $271.30M
45 S5145 Foster care, therapeutic, child; per diem $262.96M
46 99215 Prolong outpt/office vis $247.12M
47 99392 Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) $246.44M
48 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple $242.20M
49 S5130 Homemaker service, nos; per 15 minutes $236.02M
50 96361 Intravenous infusion, hydration; each additional hour $234.78M
51 90853 Group psychotherapy (other than of a multiple-family group) $228.24M
52 92014 Ophthalmological services: medical examination and evaluation, comprehensive, established patient $225.52M
53 H2018 Psychosocial rehabilitation services, per diem $223.47M
54 D8670 Periodic orthodontic treatment visit $218.53M
55 99393 Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) $217.80M
56 93306 Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete $217.28M
57 D1120 Prophylaxis - child $215.35M
58 99391 Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) $201.26M
59 T2025 Waiver services; not otherwise specified (nos) $197.72M
60 90460 Immunization administration through 18 years of age via any route, first or only component $191.57M
61 T2003 Non-emergency transportation; encounter/trip $191.55M
62 G0396 Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes $191.20M
63 74177 Computed tomography, abdomen and pelvis; with contrast material $187.69M
64 J9271 Injection, pembrolizumab, 1 mg $187.13M
65 H0005 Alcohol and/or drug services; group counseling by a clinician $186.08M
66 92004 Ophthalmological services: medical examination and evaluation, comprehensive, new patient $185.82M
67 36415 Collection of venous blood by venipuncture $182.48M
68 G0463 Hospital outpatient clinic visit for assessment and management of a patient $181.24M
69 D2392 Resin-based composite - two surfaces, posterior, primary or permanent $177.09M
70 99211 Office or other outpatient visit for the evaluation and management of an established patient, minimal severity $175.81M
71 H0004 Behavioral health counseling and therapy, per 15 minutes $175.71M
72 70450 Computed tomography, head or brain; without contrast material $175.66M
73 T1003 Lpn/lvn services, up to 15 minutes $173.30M
74 S0215 Non-emergency transportation; mileage, per mile $173.09M
75 90999 Unlisted dialysis procedure, inpatient or outpatient $170.39M
76 97112 Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination $168.51M
77 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) $166.98M
78 80053 Comprehensive metabolic panel $164.71M
79 99396 Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years $162.25M
80 88305 Level IV - Surgical pathology, gross and microscopic examination $161.52M
81 77067 Screening mammography, bilateral, including computer-aided detection $160.01M
82 A4554 Disposable underpads, all sizes $157.82M
83 G0378 Hospital observation service, per hour $155.66M
84 T1030 Nursing care, in the home, by registered nurse, per diem $150.75M
85 T1016 Case management, each 15 minutes $150.57M
86 A0428 Ambulance service, basic life support, non-emergency transport, (bls) $147.65M
87 H0044 Supported housing, per month $146.35M
88 99394 Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) $143.53M
89 T1999 Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" $142.63M
90 S5161 Emergency response system; service fee, per month (excludes installation and testing) $140.12M
91 97140 Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) $139.65M
92 92508 Group treatment of speech, language, voice, communication, and/or auditory processing disorder $137.94M
93 90847 Family psychotherapy with the patient present, 50 minutes $137.30M
94 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 $136.34M
95 T1017 Targeted case management, each 15 minutes $134.27M
96 D0999 Unspecified diagnostic procedure, by report $129.11M
97 92012 Ophthalmological services: medical examination and evaluation, intermediate, established patient $128.41M
98 96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour $128.08M
99 45380 Colonoscopy, flexible; with biopsy, single or multiple $127.56M
100 99395 Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years $127.14M
101 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 $127.06M
102 99202 Office or other outpatient visit for the evaluation and management of a new patient, straightforward $126.74M
103 H0036 Community psychiatric supportive treatment, face-to-face, per 15 minutes $126.42M
104 T4523 Adult sized disposable incontinence product, brief/diaper, large, each $124.32M
105 H2012 Behavioral health day treatment, per hour $122.45M
106 76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete $118.67M
107 G0397 Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes $118.37M
108 A0090 Non-emergency transportation, per mile - vehicle provided by individual (family member, self, neighbor) with vested interest $117.90M
109 76830 Ultrasound, transvaginal $116.95M
110 80307 Drug test(s), presumptive, any number of drug classes; immunoassay $112.52M
111 97153 Adaptive behavior treatment by protocol, administered by technician, each 15 minutes $112.17M
112 99232 Subsequent hospital care, per day, moderate complexity $109.25M
113 H2017 Psychosocial rehabilitation services, per 15 minutes $107.27M
114 90935 Hemodialysis procedure with single evaluation by a physician $107.06M
115 D0274 Bitewings - four radiographic images $104.16M
116 76700 Ultrasound, abdominal, real time with image documentation; complete $100.39M
117 S5170 Home delivered meals, including preparation; per meal $99.91M
118 H0041 Foster care, child, non-therapeutic, per diem $97.54M
119 S9131 Physical therapy; in the home, per diem $95.14M
120 90833 Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) $93.33M
121 D7210 Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth $92.58M
122 A0425 Ground mileage, per statute mile $92.39M
123 99442 $92.00M
124 G0156 Services of home health/hospice aide in home health or hospice settings, each 15 minutes $91.67M
125 T4535 Disposable liner/shield/guard/pad/undergarment, for incontinence, each $87.55M
126 90846 Family psychotherapy without the patient present, 50 minutes $87.43M
127 76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up $87.27M
128 87491 Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe $86.04M
129 A4657 Syringe, with or without needle, each $85.74M
130 31231 $84.73M
131 92557 $84.64M
132 T4522 Adult sized disposable incontinence product, brief/diaper, medium, each $83.03M
133 D0220 Intraoral - periapical first radiographic image $81.02M
134 T4524 Adult sized disposable incontinence product, brief/diaper, extra large, each $80.36M
135 87635 Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe $79.75M
136 97155 Adaptive behavior treatment with protocol modification, administered by physician, each 15 minutes $79.24M
137 90792 Psychiatric diagnostic evaluation with medical services $79.07M
138 D1351 Sealant - per tooth $78.00M
139 T1022 Contracted home health agency services, all services provided under contract, per day $77.17M
140 76641 $75.67M
141 D2391 Resin-based composite - one surface, posterior, primary or permanent $75.46M
142 E1390 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate $74.57M
143 J1745 Injection, infliximab, excludes biosimilar, 10 mg $73.70M
144 90937 $73.53M
145 92250 $72.65M
146 H2027 Psychoeducational service, per 15 minutes $72.49M
147 99281 Emergency department visit for the evaluation and management, self-limited or minor $71.98M
148 D0150 Comprehensive oral evaluation - new or established patient $71.34M
149 D2930 Prefabricated stainless steel crown - primary tooth $70.80M
150 87591 Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe $70.22M
151 82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed $68.75M
152 87633 Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets $67.70M
153 87426 Infectious agent antigen detection, SARS-CoV-2 (COVID-19) $67.69M
154 D7140 Extraction, erupted tooth or exposed root $67.61M
155 96413 Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance $66.22M
156 66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis $66.11M
157 99233 Prolong inpt eval add15 m $66.05M
158 95165 Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy, multiple dose vials $65.61M
159 J2350 Injection, ocrelizumab, 1 mg $65.26M
160 T1015 Clinic visit/encounter, all-inclusive $64.70M
161 D1208 Topical application of fluoride, excluding varnish $64.21M
162 S9122 Home health aide or certified nurse assistant, providing care in the home; per hour $64.02M
163 V2100 Sphere, single vision, plano to plus or minus 4.00, per lens $63.93M
164 D9999 Unspecified adjunctive procedure, by report $63.45M
165 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) $62.86M
166 95004 Percutaneous tests with allergenic extracts, immediate type reaction $61.87M
167 D0330 Panoramic radiographic image $61.81M
168 V2020 Frames, purchases $61.24M
169 D1206 Topical application of fluoride varnish $60.85M
170 T1001 Nursing assessment / evaluation $60.15M
171 59400 Routine obstetric care including antepartum care, vaginal delivery, and postpartum care $60.14M
172 93975 $59.70M
173 S5135 Companion care, adult (e.g., iadl/adl); per 15 minutes $59.46M
174 T2015 Habilitation, prevocational, waiver; per hour $58.47M
175 93970 $58.07M
176 96150 $56.74M
177 96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour $55.89M
178 T2024 Service assessment/plan of care development, waiver $55.66M
179 74176 Computed tomography, abdomen and pelvis; without contrast material $55.45M
180 96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular $54.58M
181 J7170 Injection, emicizumab-kxwh, 0.5 mg $53.71M
182 17110 $53.21M
183 21299 $52.78M
184 80048 Basic metabolic panel (calcium, ionized) $52.76M
185 D0230 Intraoral - periapical each additional radiographic image $52.38M
186 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 $50.39M
187 99051 $50.29M
188 A0110 Non-emergency transportation and bus, intra or inter state carrier $49.45M
189 H0038 Self-help/peer services, per 15 minutes $49.29M
190 L3000 Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each $48.69M
191 10040 $48.09M
192 96112 $47.78M
193 92083 $47.62M
194 99401 $47.14M
195 70551 Magnetic resonance imaging, brain; without contrast material $47.03M
196 77063 Screening digital breast tomosynthesis, bilateral $46.83M
197 76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal $46.58M
198 T2040 Financial management, self-directed, waiver; per 15 minutes $46.24M
199 80061 Lipid panel $46.23M
200 A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply $45.47M