All 4,016 procedure codes billed by Medicaid providers in Pennsylvania, ranked by total spending.
| # | Code | Description | Total Paid |
|---|---|---|---|
| 1 | W1793 | State-specific procedure code | $2.19B |
| 2 | T1015 | Clinic visit/encounter, all-inclusive | $2.04B |
| 3 | H2036 | Alcohol and/or other drug treatment program, per diem | $1.02B |
| 4 | S9124 | Nursing care, in the home; by licensed practical nurse, per hour | $846.79M |
| 5 | 90834 | Psychotherapy, 45 minutes with patient | $702.11M |
| 6 | W7210 | State-specific procedure code | $686.90M |
| 7 | 99284 | Emergency department visit for the evaluation and management, high severity | $657.56M |
| 8 | 97153 | Adaptive behavior treatment by protocol, administered by technician, each 15 minutes | $592.46M |
| 9 | T1017 | Targeted case management, each 15 minutes | $591.11M |
| 10 | 99214 | Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity | $558.02M |
| 11 | T1003 | Lpn/lvn services, up to 15 minutes | $512.80M |
| 12 | K0606 | Automatic external defibrillator, with integrated electrocardiogram analysis, garment type | $503.99M |
| 13 | 99213 | Office or other outpatient visit for the evaluation and management of an established patient, low complexity | $498.03M |
| 14 | H0004 | Behavioral health counseling and therapy, per 15 minutes | $497.20M |
| 15 | 99283 | Emergency department visit for the evaluation and management, moderate severity | $430.98M |
| 16 | H0018 | Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem | $426.73M |
| 17 | 99285 | Emergency department visit for the evaluation and management, high severity with immediate threat to life | $349.11M |
| 18 | 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) | $346.28M |
| 19 | H2021 | Community-based wrap-around services, per 15 minutes | $319.84M |
| 20 | 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) | $295.16M |
| 21 | G0156 | Services of home health/hospice aide in home health or hospice settings, each 15 minutes | $285.74M |
| 22 | 90837 | Psychotherapy, 53 minutes with patient | $269.46M |
| 23 | H0039 | Assertive community treatment, face-to-face, per 15 minutes | $267.65M |
| 24 | H0032 | Mental health service plan development by non-physician | $264.35M |
| 25 | T2025 | Waiver services; not otherwise specified (nos) | $257.89M |
| 26 | G9012 | Other specified case management service not elsewhere classified | $238.76M |
| 27 | H0035 | Mental health partial hospitalization, treatment, less than 24 hours | $232.75M |
| 28 | S9083 | Global fee urgent care centers | $230.03M |
| 29 | A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | $214.77M |
| 30 | W0500 | $213.85M | |
| 31 | G0378 | Hospital observation service, per hour | $209.35M |
| 32 | 97155 | Adaptive behavior treatment with protocol modification, administered by physician, each 15 minutes | $209.01M |
| 33 | H2034 | Alcohol and/or drug abuse halfway house services, per diem | $197.45M |
| 34 | 92507 | Treatment of speech, language, voice, communication, and/or auditory processing disorder | $187.54M |
| 35 | A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | $179.99M |
| 36 | S9122 | Home health aide or certified nurse assistant, providing care in the home; per hour | $179.84M |
| 37 | 90832 | Psychotherapy, 30 minutes with patient | $172.18M |
| 38 | 97530 | Therapeutic activities, direct patient contact, each 15 minutes | $171.85M |
| 39 | H0046 | Mental health services, not otherwise specified | $157.36M |
| 40 | H0013 | Alcohol and/or drug services; acute detoxification (residential addiction program outpatient) | $156.62M |
| 41 | J0584 | Injection, burosumab-twza 1 mg | $155.01M |
| 42 | T1016 | Case management, each 15 minutes | $149.70M |
| 43 | 80307 | Drug test(s), presumptive, any number of drug classes; immunoassay | $144.85M |
| 44 | H0036 | Community psychiatric supportive treatment, face-to-face, per 15 minutes | $143.92M |
| 45 | 90999 | Unlisted dialysis procedure, inpatient or outpatient | $142.52M |
| 46 | E2510 | Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access | $139.12M |
| 47 | H0038 | Self-help/peer services, per 15 minutes | $135.87M |
| 48 | S5126 | Attendant care services; per diem | $135.54M |
| 49 | 97110 | Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion | $134.19M |
| 50 | 99211 | Office or other outpatient visit for the evaluation and management of an established patient, minimal severity | $133.59M |
| 51 | T1002 | Rn services, up to 15 minutes | $131.94M |
| 52 | 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 | $128.96M |
| 53 | H2019 | Therapeutic behavioral services, per 15 minutes | $124.67M |
| 54 | 90792 | Psychiatric diagnostic evaluation with medical services | $113.75M |
| 55 | 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 | $105.00M |
| 56 | 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 | $103.21M |
| 57 | 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 | $101.96M |
| 58 | 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 | $101.55M |
| 59 | 90853 | Group psychotherapy (other than of a multiple-family group) | $91.74M |
| 60 | H0020 | Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) | $91.62M |
| 61 | H0037 | Community psychiatric supportive treatment program, per diem | $88.91M |
| 62 | H2011 | Crisis intervention service, per 15 minutes | $83.82M |
| 63 | S5161 | Emergency response system; service fee, per month (excludes installation and testing) | $81.31M |
| 64 | E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | $77.04M |
| 65 | H0034 | Medication training and support, per 15 minutes | $71.91M |
| 66 | 97151 | $68.01M | |
| 67 | G0299 | Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes | $67.37M |
| 68 | J3285 | Injection, treprostinil, 1 mg | $66.82M |
| 69 | D8670 | Periodic orthodontic treatment visit | $62.37M |
| 70 | 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | $59.14M |
| 71 | E1399 | Durable medical equipment, miscellaneous | $59.02M |
| 72 | 97154 | $57.95M | |
| 73 | W7060 | $56.92M | |
| 74 | 74177 | Computed tomography, abdomen and pelvis; with contrast material | $55.77M |
| 75 | 99215 | Prolong outpt/office vis | $54.51M |
| 76 | 99232 | Subsequent hospital care, per day, moderate complexity | $53.90M |
| 77 | A0431 | Ambulance service, conventional air services, transport, one way (rotary wing) | $53.08M |
| 78 | H2033 | Multisystemic therapy for juveniles, per 15 minutes | $52.39M |
| 79 | E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) | $50.30M |
| 80 | A4575 | Topical hyperbaric oxygen chamber, disposable | $50.09M |
| 81 | A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | $49.67M |
| 82 | S5125 | Attendant care services; per 15 minutes | $48.27M |
| 83 | V2020 | Frames, purchases | $46.22M |
| 84 | 99203 | Office or other outpatient visit for the evaluation and management of a new patient, low complexity | $45.77M |
| 85 | W9045 | $44.24M | |
| 86 | D2930 | Prefabricated stainless steel crown - primary tooth | $44.17M |
| 87 | 99204 | Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity | $42.92M |
| 88 | T2024 | Service assessment/plan of care development, waiver | $42.80M |
| 89 | 99391 | Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) | $42.53M |
| 90 | D0120 | Periodic oral evaluation - established patient | $42.42M |
| 91 | 99393 | Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) | $42.20M |
| 92 | 93229 | $40.67M | |
| 93 | D1110 | Prophylaxis - adult | $40.48M |
| 94 | V2100 | Sphere, single vision, plano to plus or minus 4.00, per lens | $39.78M |
| 95 | 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 | $39.36M |
| 96 | D1120 | Prophylaxis - child | $37.33M |
| 97 | 92508 | Group treatment of speech, language, voice, communication, and/or auditory processing disorder | $37.28M |
| 98 | T1000 | Private duty / independent nursing service(s) - licensed, up to 15 minutes | $36.26M |
| 99 | 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | $36.00M |
| 100 | D7140 | Extraction, erupted tooth or exposed root | $35.12M |
| 101 | 90847 | Family psychotherapy with the patient present, 50 minutes | $34.67M |
| 102 | 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 | $33.93M |
| 103 | A9276 | Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply | $33.84M |
| 104 | D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | $33.78M |
| 105 | A0425 | Ground mileage, per statute mile | $33.58M |
| 106 | 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 | $32.86M |
| 107 | 90791 | Psychiatric diagnostic evaluation | $32.84M |
| 108 | T4527 | Adult sized disposable incontinence product, protective underwear/pull-on, large size, each | $32.08M |
| 109 | 93306 | Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete | $32.08M |
| 110 | E0466 | Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) | $32.03M |
| 111 | 92014 | Ophthalmological services: medical examination and evaluation, comprehensive, established patient | $31.88M |
| 112 | E2599 | Accessory for speech generating device, not otherwise classified | $31.72M |
| 113 | 99233 | Prolong inpt eval add15 m | $30.79M |
| 114 | 99282 | Emergency department visit for the evaluation and management, low to moderate severity | $30.52M |
| 115 | 80053 | Comprehensive metabolic panel | $30.05M |
| 116 | H2035 | Alcohol and/or other drug treatment program, per hour | $29.71M |
| 117 | W0016 | $29.35M | |
| 118 | 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 | $28.86M |
| 119 | 70450 | Computed tomography, head or brain; without contrast material | $28.81M |
| 120 | S5150 | Unskilled respite care, not hospice; per 15 minutes | $28.27M |
| 121 | J1745 | Injection, infliximab, excludes biosimilar, 10 mg | $28.26M |
| 122 | D1351 | Sealant - per tooth | $28.19M |
| 123 | H0047 | Alcohol and/or other drug abuse services, not otherwise specified | $27.71M |
| 124 | T2041 | Supports brokerage, self-directed, waiver; per 15 minutes | $27.57M |
| 125 | A0434 | Specialty care transport (sct) | $27.48M |
| 126 | J7170 | Injection, emicizumab-kxwh, 0.5 mg | $27.24M |
| 127 | 88305 | Level IV - Surgical pathology, gross and microscopic examination | $27.20M |
| 128 | 43239 | Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple | $25.02M |
| 129 | D9223 | Deep sedation/general anesthesia - each subsequent 15 minute increment | $24.70M |
| 130 | D1206 | Topical application of fluoride varnish | $24.50M |
| 131 | S9485 | Crisis intervention mental health services, per diem | $24.37M |
| 132 | T4535 | Disposable liner/shield/guard/pad/undergarment, for incontinence, each | $24.28M |
| 133 | T4526 | Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each | $24.25M |
| 134 | W9047 | $24.09M | |
| 135 | E0601 | Continuous positive airway pressure (cpap) device | $23.97M |
| 136 | 77067 | Screening mammography, bilateral, including computer-aided detection | $23.60M |
| 137 | 99394 | Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) | $23.14M |
| 138 | 93010 | Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only | $22.79M |
| 139 | 99309 | Subsequent nursing facility care, per day, low to moderate complexity | $22.73M |
| 140 | H2030 | Mental health clubhouse services, per 15 minutes | $22.42M |
| 141 | 97112 | Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination | $22.37M |
| 142 | G0151 | Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes | $22.01M |
| 143 | T4534 | Youth sized disposable incontinence product, protective underwear/pull-on, each | $21.97M |
| 144 | H0006 | Alcohol and/or drug services; case management | $21.84M |
| 145 | D7210 | Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth | $21.69M |
| 146 | 85025 | Blood count; complete (CBC), automated, and automated differential WBC count | $21.46M |
| 147 | S9088 | Services provided in an urgent care center (list in addition to code for service) | $20.92M |
| 148 | T4528 | Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each | $20.76M |
| 149 | 87491 | Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe | $20.22M |
| 150 | W9029 | $20.07M | |
| 151 | J9271 | Injection, pembrolizumab, 1 mg | $19.87M |
| 152 | J0638 | Injection, canakinumab, 1 mg | $19.84M |
| 153 | 97156 | $19.80M | |
| 154 | A7030 | Full face mask used with positive airway pressure device, each | $19.55M |
| 155 | 0202U | Oncology (prostate), multianalyte, gene expression profiling | $19.48M |
| 156 | 76816 | Ultrasound, pregnant uterus, real time with image documentation, follow-up | $19.15M |
| 157 | 92004 | Ophthalmological services: medical examination and evaluation, comprehensive, new patient | $18.76M |
| 158 | 87591 | Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe | $18.72M |
| 159 | T4541 | Incontinence product, disposable underpad, large, each | $18.67M |
| 160 | J1726 | Injection, hydroxyprogesterone caproate, (makena), 10 mg | $18.63M |
| 161 | 99291 | Critical care, evaluation and management of the critically ill patient, first 30-74 minutes | $18.63M |
| 162 | E0603 | Breast pump, electric (ac and/or dc), any type | $18.55M |
| 163 | D0274 | Bitewings - four radiographic images | $18.40M |
| 164 | 90935 | Hemodialysis procedure with single evaluation by a physician | $18.28M |
| 165 | 97140 | Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) | $18.05M |
| 166 | D8080 | Comprehensive orthodontic treatment of the adolescent dentition | $18.05M |
| 167 | D9420 | $18.00M | |
| 168 | T4543 | Adult sized disposable incontinence product, protective brief/diaper, above extra large, each | $17.95M |
| 169 | 96374 | Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance | $17.70M |
| 170 | T2016 | Habilitation, residential, waiver; per diem | $17.65M |
| 171 | S5145 | Foster care, therapeutic, child; per diem | $17.48M |
| 172 | E0194 | Air fluidized bed | $17.42M |
| 173 | T4523 | Adult sized disposable incontinence product, brief/diaper, large, each | $17.31M |
| 174 | 71045 | Radiologic examination, chest; single view | $17.07M |
| 175 | B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | $16.84M |
| 176 | S5170 | Home delivered meals, including preparation; per meal | $16.84M |
| 177 | S5130 | Homemaker service, nos; per 15 minutes | $16.65M |
| 178 | 99244 | Office or other outpatient consultation, moderate to high complexity | $16.60M |
| 179 | G0463 | Hospital outpatient clinic visit for assessment and management of a patient | $16.60M |
| 180 | T4537 | Incontinence product, protective underpad, reusable, bed size, each | $16.52M |
| 181 | D2391 | Resin-based composite - one surface, posterior, primary or permanent | $16.37M |
| 182 | A4927 | Gloves, non-sterile, per 100 | $15.94M |
| 183 | 80061 | Lipid panel | $15.39M |
| 184 | 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 | $15.34M |
| 185 | J1561 | Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg | $15.25M |
| 186 | 71046 | Radiologic examination, chest; 2 views | $15.23M |
| 187 | H2014 | Skills training and development, per 15 minutes | $15.22M |
| 188 | 84443 | Thyroid stimulating hormone (TSH) | $15.22M |
| 189 | D0150 | Comprehensive oral evaluation - new or established patient | $15.12M |
| 190 | W1895 | $14.82M | |
| 191 | S9363 | Home infusion therapy, anti-spasmotic therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | $14.68M |
| 192 | V2784 | Lens, polycarbonate or equal, any index, per lens | $14.59M |
| 193 | 97152 | $14.56M | |
| 194 | 80050 | General health panel | $14.48M |
| 195 | 96413 | Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance | $14.47M |
| 196 | 70553 | Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences | $14.04M |
| 197 | A4353 | Intermittent urinary catheter, with insertion supplies | $14.03M |
| 198 | 82306 | Vitamin D; 25 hydroxy, includes fraction(s), if performed | $13.98M |
| 199 | Q5003 | Hospice care provided in nursing long term care facility (ltc) or non-skilled nursing facility (nf) | $13.87M |
| 200 | D9222 | $13.65M |