Medicaid Provider Spending

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

Billing Codes in Tennessee

All 3,939 procedure codes billed by Medicaid providers in Tennessee, ranked by total spending.

#CodeDescriptionTotal Paid
1 T2033 Residential care, not otherwise specified (nos), waiver; per diem $3.04B
2 T2023 Targeted case management; per month $1.05B
3 S0280 Medical home program, comprehensive care coordination and planning, initial plan $853.17M
4 99214 Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity $760.69M
5 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) $760.14M
6 99213 Office or other outpatient visit for the evaluation and management of an established patient, low complexity $745.00M
7 99284 Emergency department visit for the evaluation and management, high severity $684.48M
8 S5125 Attendant care services; per 15 minutes $603.35M
9 99283 Emergency department visit for the evaluation and management, moderate severity $542.12M
10 T2016 Habilitation, residential, waiver; per diem $533.36M
11 H0043 Supported housing, per diem $372.06M
12 99285 Emergency department visit for the evaluation and management, high severity with immediate threat to life $361.33M
13 T2021 Day habilitation, waiver; per 15 minutes $352.92M
14 H0037 Community psychiatric supportive treatment program, per diem $310.73M
15 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 $286.00M
16 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 $247.23M
17 H2020 Therapeutic behavioral services, per diem $214.07M
18 T2025 Waiver services; not otherwise specified (nos) $212.68M
19 T2020 Day habilitation, waiver; per diem $209.50M
20 A0427 Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) $169.09M
21 T2012 Habilitation, educational; waiver, per diem $160.08M
22 90834 Psychotherapy, 45 minutes with patient $149.20M
23 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder $144.32M
24 90460 Immunization administration through 18 years of age via any route, first or only component $126.27M
25 90837 Psychotherapy, 53 minutes with patient $123.43M
26 H2025 Ongoing support to maintain employment, per 15 minutes $122.73M
27 97530 Therapeutic activities, direct patient contact, each 15 minutes $121.09M
28 T2022 Case management, per month $119.95M
29 90999 Unlisted dialysis procedure, inpatient or outpatient $107.71M
30 H0036 Community psychiatric supportive treatment, face-to-face, per 15 minutes $99.46M
31 99204 Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity $97.81M
32 99392 Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) $97.09M
33 A0425 Ground mileage, per statute mile $94.82M
34 T1000 Private duty / independent nursing service(s) - licensed, up to 15 minutes $92.09M
35 D1120 Prophylaxis - child $89.49M
36 H0016 Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting) $87.18M
37 99391 Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) $84.28M
38 J2326 Injection, nusinersen, 0.1 mg $80.91M
39 D0120 Periodic oral evaluation - established patient $77.04M
40 G0463 Hospital outpatient clinic visit for assessment and management of a patient $70.30M
41 A0429 Ambulance service, basic life support, emergency transport (bls-emergency) $70.25M
42 99393 Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) $67.52M
43 90832 Psychotherapy, 30 minutes with patient $66.25M
44 99203 Office or other outpatient visit for the evaluation and management of a new patient, low complexity $66.01M
45 D2930 Prefabricated stainless steel crown - primary tooth $65.03M
46 99232 Subsequent hospital care, per day, moderate complexity $62.15M
47 80307 Drug test(s), presumptive, any number of drug classes; immunoassay $61.17M
48 97110 Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion $61.01M
49 G0482 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; 15-21 drug class(es), including metabolite(s) if performed $59.39M
50 H0035 Mental health partial hospitalization, treatment, less than 24 hours $58.92M
51 H0020 Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) $57.67M
52 96110 Developmental screening, with scoring and documentation, per standardized instrument $55.21M
53 E1390 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate $52.52M
54 99233 Prolong inpt eval add15 m $51.66M
55 D2392 Resin-based composite - two surfaces, posterior, primary or permanent $49.95M
56 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 $49.85M
57 D1110 Prophylaxis - adult $48.25M
58 D1206 Topical application of fluoride varnish $46.99M
59 99282 Emergency department visit for the evaluation and management, low to moderate severity $45.20M
60 H2017 Psychosocial rehabilitation services, per 15 minutes $44.61M
61 90791 Psychiatric diagnostic evaluation $44.33M
62 99469 Subsequent inpatient neonatal critical care, per day, 28 days or younger $43.88M
63 H0044 Supported housing, per month $43.68M
64 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 $42.97M
65 92014 Ophthalmological services: medical examination and evaluation, comprehensive, established patient $42.82M
66 H2019 Therapeutic behavioral services, per 15 minutes $40.75M
67 99472 Subsequent inpatient pediatric critical care, per day, 2-5 years $39.38M
68 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 $38.80M
69 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 $38.34M
70 T1003 Lpn/lvn services, up to 15 minutes $37.41M
71 A0110 Non-emergency transportation and bus, intra or inter state carrier $36.32M
72 S5136 Companion care, adult (e.g., iadl/adl); per diem $36.28M
73 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 $35.78M
74 87804 Infectious agent antigen detection by immunoassay; Influenza, each type $35.52M
75 99215 Prolong outpt/office vis $35.32M
76 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple $35.16M
77 97153 Adaptive behavior treatment by protocol, administered by technician, each 15 minutes $34.98M
78 99394 Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) $34.60M
79 E0760 Osteogenesis stimulator, low intensity ultrasound, non-invasive $34.29M
80 J1726 Injection, hydroxyprogesterone caproate, (makena), 10 mg $33.87M
81 88305 Level IV - Surgical pathology, gross and microscopic examination $33.86M
82 D8670 Periodic orthodontic treatment visit $33.38M
83 59400 Routine obstetric care including antepartum care, vaginal delivery, and postpartum care $33.20M
84 74177 Computed tomography, abdomen and pelvis; with contrast material $32.99M
85 H0014 Alcohol and/or drug services; ambulatory detoxification $32.84M
86 76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up $32.63M
87 76819 Fetal biophysical profile; without non-stress testing $32.54M
88 H2033 Multisystemic therapy for juveniles, per 15 minutes $32.41M
89 G9002 Coordinated care fee, maintenance rate $31.61M
90 D1208 Topical application of fluoride, excluding varnish $31.54M
91 H0033 Oral medication administration, direct observation $31.30M
92 T1015 Clinic visit/encounter, all-inclusive $31.24M
93 T2030 Assisted living, waiver; per month $30.96M
94 D2391 Resin-based composite - one surface, posterior, primary or permanent $30.75M
95 B4035 Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape $30.60M
96 S5145 Foster care, therapeutic, child; per diem $30.56M
97 D7140 Extraction, erupted tooth or exposed root $30.55M
98 93306 Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete $30.34M
99 87635 Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe $29.52M
100 95165 Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy, multiple dose vials $28.76M
101 99212 Office or other outpatient visit for the evaluation and management of an established patient, straightforward $27.81M
102 85025 Blood count; complete (CBC), automated, and automated differential WBC count $27.74M
103 S5150 Unskilled respite care, not hospice; per 15 minutes $27.72M
104 42820 Tonsillectomy and adenoidectomy; younger than age 12 $27.60M
105 92015 Determination of refractive state $27.44M
106 69436 Tympanostomy (requiring insertion of ventilating tube), general anesthesia $27.40M
107 96374 Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance $27.36M
108 H2018 Psychosocial rehabilitation services, per diem $26.11M
109 T2019 Habilitation, supported employment, waiver; per 15 minutes $25.77M
110 G0378 Hospital observation service, per hour $25.75M
111 99223 Prolong inpt eval add15 m $25.59M
112 96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular $24.48M
113 92004 Ophthalmological services: medical examination and evaluation, comprehensive, new patient $24.31M
114 E0603 Breast pump, electric (ac and/or dc), any type $24.29M
115 87428 $24.01M
116 87426 Infectious agent antigen detection, SARS-CoV-2 (COVID-19) $23.85M
117 A0428 Ambulance service, basic life support, non-emergency transport, (bls) $23.83M
118 87880 Infectious agent antigen detection by immunoassay; Streptococcus, group A $23.83M
119 01967 Neuraxial labor analgesia/anesthesia for planned vaginal delivery $23.06M
120 D0330 Panoramic radiographic image $22.34M
121 87811 Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) $22.25M
122 J2357 Injection, omalizumab, 5 mg $22.13M
123 D9230 Inhalation of nitrous oxide / analgesia, anxiolysis $22.00M
124 D0150 Comprehensive oral evaluation - new or established patient $21.80M
125 41899 Unlisted procedure, dentoalveolar structures $21.58M
126 H0010 Alcohol and/or drug services; sub-acute detoxification (residential addiction program inpatient) $21.16M
127 S9122 Home health aide or certified nurse assistant, providing care in the home; per hour $20.94M
128 D0272 Bitewings - two radiographic images $20.75M
129 87502 Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets $20.69M
130 H2022 Community-based wrap-around services, per diem $20.53M
131 Q9992 Injection, buprenorphine extended-release (sublocade), greater than 100 mg $20.47M
132 Q5003 Hospice care provided in nursing long term care facility (ltc) or non-skilled nursing facility (nf) $20.17M
133 76811 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed $20.12M
134 D7240 Removal of impacted tooth - completely bony $19.77M
135 D1351 Sealant - per tooth $19.75M
136 H2016 Comprehensive community support services, per diem $19.36M
137 90847 Family psychotherapy with the patient present, 50 minutes $19.34M
138 70450 Computed tomography, head or brain; without contrast material $19.18M
139 99479 Subsequent intensive care, per day, very low birth weight infant $18.94M
140 D3220 Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction $18.92M
141 A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply $18.73M
142 92340 Fitting of spectacles, except for aphakia; monofocal $18.63M
143 99309 Subsequent nursing facility care, per day, low to moderate complexity $18.58M
144 90792 Psychiatric diagnostic evaluation with medical services $17.21M
145 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 $16.82M
146 71045 Radiologic examination, chest; single view $16.56M
147 D0274 Bitewings - four radiographic images $16.34M
148 A0431 Ambulance service, conventional air services, transport, one way (rotary wing) $16.32M
149 H2011 Crisis intervention service, per 15 minutes $16.28M
150 87651 Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe $16.20M
151 E1399 Durable medical equipment, miscellaneous $16.05M
152 76820 $16.00M
153 87491 Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe $15.94M
154 99308 Subsequent nursing facility care, per day, straightforward $15.79M
155 Q9991 Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg $15.71M
156 80053 Comprehensive metabolic panel $15.67M
157 99291 Critical care, evaluation and management of the critically ill patient, first 30-74 minutes $15.57M
158 87591 Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe $15.52M
159 99343 $14.41M
160 95004 Percutaneous tests with allergenic extracts, immediate type reaction $14.35M
161 H2015 Comprehensive community support services, per 15 minutes $14.35M
162 99480 Subsequent intensive care, per day, low birth weight infant $14.33M
163 92508 Group treatment of speech, language, voice, communication, and/or auditory processing disorder $14.16M
164 E0465 Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) $14.10M
165 93303 Transthoracic echocardiography for congenital cardiac anomalies, follow-up or limited study $14.04M
166 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 $13.56M
167 99349 $13.55M
168 00170 Anesthesia for intraoral procedures, including biopsy $13.49M
169 0241U Neonatal screening for hereditary disorders, genomic sequence analysis panel $13.41M
170 76805 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation $13.26M
171 J0585 Injection, onabotulinumtoxina, 1 unit $12.76M
172 H2010 Comprehensive medication services, per 15 minutes $12.39M
173 D0220 Intraoral - periapical first radiographic image $12.25M
174 G9012 Other specified case management service not elsewhere classified $12.18M
175 V2020 Frames, purchases $11.98M
176 T2046 Hospice long term care, room and board only; per diem $11.91M
177 99238 Hospital discharge day management, 30 minutes or less $11.82M
178 71046 Radiologic examination, chest; 2 views $11.80M
179 E0466 Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) $11.68M
180 95117 $11.59M
181 D3330 Endodontic therapy, molar tooth (excluding final restoration) $11.59M
182 D7210 Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth $11.36M
183 H2012 Behavioral health day treatment, per hour $11.29M
184 97140 Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) $11.19M
185 36415 Collection of venous blood by venipuncture $10.93M
186 V2784 Lens, polycarbonate or equal, any index, per lens $10.92M
187 96413 Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance $10.91M
188 G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes $10.86M
189 D9223 Deep sedation/general anesthesia - each subsequent 15 minute increment $10.79M
190 74176 Computed tomography, abdomen and pelvis; without contrast material $10.76M
191 96160 $10.76M
192 D9248 $10.59M
193 A0130 Non-emergency transportation: wheelchair van $10.54M
194 76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal $10.43M
195 D0210 Intraoral - complete series of radiographic images $10.08M
196 H0032 Mental health service plan development by non-physician $9.99M
197 45380 Colonoscopy, flexible; with biopsy, single or multiple $9.96M
198 99395 Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years $9.68M
199 99239 Hospital discharge day management, more than 30 minutes $9.67M
200 97112 Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination $9.64M