Medicaid Provider Spending

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

Billing Codes in Rhode Island

All 2,005 procedure codes billed by Medicaid providers in Rhode Island, ranked by total spending.

#CodeDescriptionTotal Paid
1 T2033 Residential care, not otherwise specified (nos), waiver; per diem $877.42M
2 S5125 Attendant care services; per 15 minutes $650.84M
3 T2017 Habilitation, residential, waiver; 15 minutes $381.60M
4 T2021 Day habilitation, waiver; per 15 minutes $330.64M
5 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 $242.72M
6 H0037 Community psychiatric supportive treatment program, per diem $217.97M
7 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) $171.68M
8 99213 Office or other outpatient visit for the evaluation and management of an established patient, low complexity $148.23M
9 T2046 Hospice long term care, room and board only; per diem $146.26M
10 80307 Drug test(s), presumptive, any number of drug classes; immunoassay $134.85M
11 99214 Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity $128.97M
12 H0040 Assertive community treatment program, per diem $126.28M
13 H0020 Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) $119.46M
14 T1015 Clinic visit/encounter, all-inclusive $111.21M
15 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 $95.62M
16 99284 Emergency department visit for the evaluation and management, high severity $89.90M
17 T1024 Evaluation and treatment by an integrated, specialty team contracted to provide coordinated care to multiple or severely handicapped children, per encounter $88.60M
18 99285 Emergency department visit for the evaluation and management, high severity with immediate threat to life $80.83M
19 S5102 Day care services, adult; per diem $77.21M
20 T2031 Assisted living; waiver, per diem $72.25M
21 90834 Psychotherapy, 45 minutes with patient $70.85M
22 99283 Emergency department visit for the evaluation and management, moderate severity $64.85M
23 S5130 Homemaker service, nos; per 15 minutes $64.76M
24 T2003 Non-emergency transportation; encounter/trip $58.75M
25 H0046 Mental health services, not otherwise specified $48.72M
26 T2022 Case management, per month $47.26M
27 T1016 Case management, each 15 minutes $42.47M
28 90999 Unlisted dialysis procedure, inpatient or outpatient $37.10M
29 T1027 Family training and counseling for child development, per 15 minutes $36.48M
30 G0378 Hospital observation service, per hour $35.34M
31 90837 Psychotherapy, 53 minutes with patient $34.56M
32 H0047 Alcohol and/or other drug abuse services, not otherwise specified $34.20M
33 T2025 Waiver services; not otherwise specified (nos) $32.93M
34 97110 Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion $32.76M
35 S5136 Companion care, adult (e.g., iadl/adl); per diem $30.60M
36 H2019 Therapeutic behavioral services, per 15 minutes $29.44M
37 T1000 Private duty / independent nursing service(s) - licensed, up to 15 minutes $28.89M
38 T1005 Respite care services, up to 15 minutes $28.23M
39 85025 Blood count; complete (CBC), automated, and automated differential WBC count $25.32M
40 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 $25.32M
41 T2016 Habilitation, residential, waiver; per diem $24.86M
42 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) $24.81M
43 H2014 Skills training and development, per 15 minutes $23.97M
44 H2018 Psychosocial rehabilitation services, per diem $22.47M
45 99211 Office or other outpatient visit for the evaluation and management of an established patient, minimal severity $21.64M
46 87491 Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe $21.35M
47 H2001 Rehabilitation program, per 1/2 day $19.88M
48 H0035 Mental health partial hospitalization, treatment, less than 24 hours $18.03M
49 97150 Therapeutic procedure(s), group (2 or more individuals) $17.88M
50 87591 Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe $17.88M
51 H0004 Behavioral health counseling and therapy, per 15 minutes $17.45M
52 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 $16.86M
53 H0036 Community psychiatric supportive treatment, face-to-face, per 15 minutes $16.69M
54 T1041 Medicaid certified community behavioral health clinic services, per month $16.29M
55 J1745 Injection, infliximab, excludes biosimilar, 10 mg $15.93M
56 97530 Therapeutic activities, direct patient contact, each 15 minutes $15.01M
57 S9124 Nursing care, in the home; by licensed practical nurse, per hour $14.82M
58 D1120 Prophylaxis - child $14.35M
59 99479 Subsequent intensive care, per day, very low birth weight infant $14.34M
60 99203 Office or other outpatient visit for the evaluation and management of a new patient, low complexity $13.90M
61 80053 Comprehensive metabolic panel $13.76M
62 T1030 Nursing care, in the home, by registered nurse, per diem $13.75M
63 S9122 Home health aide or certified nurse assistant, providing care in the home; per hour $13.30M
64 T2020 Day habilitation, waiver; per diem $12.97M
65 A0429 Ambulance service, basic life support, emergency transport (bls-emergency) $12.69M
66 80048 Basic metabolic panel (calcium, ionized) $12.64M
67 96413 Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance $12.61M
68 96375 Therapeutic injection; each additional sequential IV push $12.53M
69 S5135 Companion care, adult (e.g., iadl/adl); per 15 minutes $12.45M
70 S9485 Crisis intervention mental health services, per diem $12.37M
71 99212 Office or other outpatient visit for the evaluation and management of an established patient, straightforward $12.33M
72 99204 Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity $12.09M
73 D1206 Topical application of fluoride varnish $11.61M
74 88305 Level IV - Surgical pathology, gross and microscopic examination $11.56M
75 97140 Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) $11.15M
76 Q5103 Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg $10.88M
77 A0427 Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) $10.65M
78 92508 Group treatment of speech, language, voice, communication, and/or auditory processing disorder $10.62M
79 93306 Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete $10.52M
80 90791 Psychiatric diagnostic evaluation $10.19M
81 T2019 Habilitation, supported employment, waiver; per 15 minutes $9.64M
82 74177 Computed tomography, abdomen and pelvis; with contrast material $9.58M
83 90832 Psychotherapy, 30 minutes with patient $9.51M
84 93005 Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report $9.47M
85 80061 Lipid panel $9.46M
86 D8670 Periodic orthodontic treatment visit $9.29M
87 90792 Psychiatric diagnostic evaluation with medical services $9.06M
88 H2016 Comprehensive community support services, per diem $8.99M
89 82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed $8.93M
90 36415 Collection of venous blood by venipuncture $8.92M
91 99282 Emergency department visit for the evaluation and management, low to moderate severity $8.92M
92 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder $8.81M
93 96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour $8.64M
94 99215 Prolong outpt/office vis $8.61M
95 70553 Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences $8.58M
96 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) $8.46M
97 H2022 Community-based wrap-around services, per diem $8.46M
98 77067 Screening mammography, bilateral, including computer-aided detection $8.24M
99 80050 General health panel $8.07M
100 D0120 Periodic oral evaluation - established patient $7.92M
101 H2000 Comprehensive multidisciplinary evaluation $7.88M
102 84443 Thyroid stimulating hormone (TSH) $7.84M
103 J9271 Injection, pembrolizumab, 1 mg $7.74M
104 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 $7.60M
105 99392 Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) $7.59M
106 D1110 Prophylaxis - adult $7.55M
107 01967 Neuraxial labor analgesia/anesthesia for planned vaginal delivery $7.28M
108 96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular $7.26M
109 96374 Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance $7.26M
110 S9131 Physical therapy; in the home, per diem $7.24M
111 J2405 Injection, ondansetron hydrochloride, per 1 mg $7.05M
112 T1001 Nursing assessment / evaluation $6.91M
113 87389 Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies $6.88M
114 71046 Radiologic examination, chest; 2 views $6.81M
115 99232 Subsequent hospital care, per day, moderate complexity $6.74M
116 92014 Ophthalmological services: medical examination and evaluation, comprehensive, established patient $6.66M
117 90833 Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) $6.58M
118 D7140 Extraction, erupted tooth or exposed root $6.54M
119 83036 Hemoglobin; glycosylated (A1C) $6.49M
120 T2041 Supports brokerage, self-directed, waiver; per 15 minutes $6.48M
121 87651 Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe $6.37M
122 D8080 Comprehensive orthodontic treatment of the adolescent dentition $6.35M
123 T2015 Habilitation, prevocational, waiver; per hour $6.34M
124 T1002 Rn services, up to 15 minutes $6.33M
125 83735 $6.23M
126 99393 Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) $6.15M
127 A0428 Ambulance service, basic life support, non-emergency transport, (bls) $6.14M
128 99391 Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) $6.08M
129 T1017 Targeted case management, each 15 minutes $5.98M
130 96361 Intravenous infusion, hydration; each additional hour $5.88M
131 81001 $5.86M
132 99600 Unlisted home visit service or procedure $5.82M
133 J1100 Injection, dexamethasone sodium phosphate, 1 mg $5.61M
134 X0215 $5.54M
135 V2020 Frames, purchases $5.53M
136 Q9967 Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml $5.49M
137 90460 Immunization administration through 18 years of age via any route, first or only component $5.44M
138 88175 Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer $5.43M
139 87624 Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types $5.40M
140 84484 $5.24M
141 J7030 Infusion, normal saline solution , 1000 cc $5.12M
142 77386 $5.05M
143 D2392 Resin-based composite - two surfaces, posterior, primary or permanent $5.04M
144 J2323 Injection, natalizumab, 1 mg $5.01M
145 V2103 Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens $4.88M
146 J7040 Infusion, normal saline solution, sterile (500 ml = 1 unit) $4.82M
147 J1642 Injection, heparin sodium, (heparin lock flush), per 10 units $4.80M
148 H0010 Alcohol and/or drug services; sub-acute detoxification (residential addiction program inpatient) $4.68M
149 70450 Computed tomography, head or brain; without contrast material $4.67M
150 H2023 Supported employment, per 15 minutes $4.64M
151 92015 Determination of refractive state $4.59M
152 86803 $4.53M
153 95810 Polysomnography; sleep staging with 4 or more additional parameters $4.49M
154 82248 $4.43M
155 J2501 Injection, paricalcitol, 1 mcg $4.38M
156 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 $4.33M
157 85027 $4.32M
158 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple $4.29M
159 97112 Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination $4.26M
160 90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine $4.24M
161 X0377 $4.21M
162 S5170 Home delivered meals, including preparation; per meal $4.17M
163 76818 $4.12M
164 D7210 Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth $4.11M
165 87086 Culture, bacterial; quantitative colony count, urine $4.11M
166 99233 Prolong inpt eval add15 m $4.09M
167 83690 $4.08M
168 99394 Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) $4.03M
169 84100 $4.03M
170 87633 Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets $4.02M
171 87428 $3.97M
172 82728 $3.95M
173 D8660 $3.90M
174 J2350 Injection, ocrelizumab, 1 mg $3.90M
175 T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter $3.84M
176 85610 $3.83M
177 J2250 Injection, midazolam hydrochloride, per 1 mg $3.80M
178 76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up $3.77M
179 J7050 Infusion, normal saline solution, 250 cc $3.74M
180 J3490 Unclassified drugs $3.73M
181 J3010 Injection, fentanyl citrate, 0.1 mg $3.72M
182 86780 $3.69M
183 T1003 Lpn/lvn services, up to 15 minutes $3.63M
184 D1351 Sealant - per tooth $3.62M
185 86850 $3.62M
186 T4535 Disposable liner/shield/guard/pad/undergarment, for incontinence, each $3.56M
187 80076 $3.54M
188 H2031 Mental health clubhouse services, per diem $3.50M
189 92340 Fitting of spectacles, except for aphakia; monofocal $3.49M
190 G0463 Hospital outpatient clinic visit for assessment and management of a patient $3.46M
191 E1390 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate $3.43M
192 J0690 Injection, cefazolin sodium, 500 mg $3.40M
193 A0425 Ground mileage, per statute mile $3.33M
194 S5161 Emergency response system; service fee, per month (excludes installation and testing) $3.27M
195 D1208 Topical application of fluoride, excluding varnish $3.27M
196 J2704 Injection, propofol, 10 mg $3.26M
197 59025 Fetal non-stress test $3.25M
198 76830 Ultrasound, transvaginal $3.24M
199 96367 $3.16M
200 86900 $3.16M