Pennsylvania Medicaid Reimbursement Rates
What Medicaid pays for medical procedures and services in Pennsylvania, based on 2024 claims data.
2024 Overview
Procedures
2.8K
Total Claims
65.4M
Total Paid
$5.8B
Popular Services
Procedures
Showing 1–50 of 2,827 procedures, sorted by most claims.
| HCPCS Code | Description | Total Claims | Avg Payment | Min Payment | Max Payment |
|---|---|---|---|---|---|
| 99213 | Office o/p est low 20 min | 2,734,255 | $42.40 | $0.00 | $351.22 |
| 99214 | Office o/p est mod 30 min | 2,347,933 | $62.14 | $0.00 | $316.30 |
| T1015 | Clinic service | 2,165,472 | $208.65 | $0.00 | $850.00 |
| H0020 | Alcohol and/or drug services | 2,137,975 | $8.96 | $0.00 | $400.00 |
| 90834 | Psytx w pt 45 minutes | 1,792,203 | $98.53 | $0.00 | $290.29 |
| 99284 | Emergency dept visit mod mdm | 1,097,540 | $146.99 | $0.00 | $909.64 |
| T1017 | Targeted case management | 1,085,661 | $126.43 | $0.00 | $403.71 |
| G0156 | Hhcp-svs of aide,ea 15 min | 1,072,192 | $218.43 | $0.00 | $302.76 |
| H2036 | A/d tx program, per diem | 942,423 | $426.73 | $132.30 | $10,777.54 |
| 97153 | Adaptive behavior tx by tech | 826,391 | $264.60 | $16.61 | $6,698.03 |
| D0120 | Periodic oral evaluation | 826,068 | $21.86 | $0.00 | $563.93 |
| 85025 | Complete cbc w/auto diff wbc | 783,497 | $4.55 | $0.00 | $251.44 |
| H2021 | Com wrap-around sv, 15 min | 686,398 | $133.29 | $0.00 | $624.13 |
| H0004 | Alcohol and/or drug services | 672,015 | $193.95 | $0.00 | $1,000.62 |
| 90837 | Psytx w pt 60 minutes | 658,560 | $120.20 | $0.00 | $746.05 |
| 90832 | Psytx w pt 30 minutes | 651,509 | $66.05 | $0.00 | $285.00 |
| 97530 | Therapeutic activities | 643,541 | $44.16 | $0.00 | $398.03 |
| D1330 | Oral hygiene instructions | 612,505 | $6.99 | $0.00 | $36.43 |
| D1206 | Topical fluoride varnish | 611,059 | $19.92 | $0.00 | $97.02 |
| T1003 | Lpn/lvn services up to 15min | 609,871 | $493.26 | $24.73 | $1,854.42 |
| 93010 | Electrocardiogram report | 605,306 | $7.98 | $0.00 | $48.76 |
| 99283 | Emergency dept visit low mdm | 596,785 | $147.15 | $0.00 | $760.04 |
| 80053 | Comprehen metabolic panel | 587,619 | $8.30 | $0.00 | $556.77 |
| S5161 | Emer rspns sys serv permonth | 561,976 | $23.76 | $9.01 | $70.09 |
| 92507 | Tx sp lang voice comm indiv | 545,401 | $59.71 | $0.00 | $585.31 |
| S9083 | Urgent care center global | 518,433 | $111.71 | $0.00 | $245.00 |
| 80307 | Drug test prsmv chem anlyzr | 515,007 | $40.18 | $0.00 | $144.74 |
| 99285 | Emergency dept visit hi mdm | 512,334 | $173.16 | $0.00 | $2,226.07 |
| D1110 | Dental prophylaxis adult | 512,259 | $34.53 | $0.00 | $771.33 |
| 97110 | Therapeutic exercises | 504,514 | $43.83 | $0.00 | $526.66 |
| D1120 | Dental prophylaxis child | 496,890 | $31.52 | $0.00 | $1,073.18 |
| D1310 | Nutri counsel-control caries | 448,197 | $7.47 | $0.00 | $46.00 |
| 36415 | Coll venous bld venipuncture | 444,507 | $2.28 | $0.00 | $112.00 |
| D1351 | Dental sealant per tooth | 437,435 | $30.43 | $0.00 | $1,181.60 |
| H0032 | Mh svc plan dev by non-md | 403,515 | $201.64 | $0.00 | $520.83 |
| 90853 | Group psychotherapy | 397,870 | $58.69 | $0.00 | $207.13 |
| 92508 | Tx sp lang voice comm group | 379,579 | $10.64 | $0.96 | $28.31 |
| H0035 | Mh partial hosp tx under 24h | 378,584 | $194.81 | $18.53 | $824.68 |
| 71045 | X-ray exam chest 1 view | 372,897 | $7.42 | $0.00 | $97.50 |
| D0220 | Intraoral periapical first | 371,901 | $7.71 | $0.00 | $104.49 |
| A0425 | Ground mileage | 357,776 | $66.13 | $0.00 | $896.98 |
| D0274 | Bitewings four images | 347,767 | $25.23 | $0.00 | $81.25 |
| H0039 | Asser com tx face-face/15min | 345,078 | $214.18 | $0.00 | $1,703.76 |
| H0034 | Med trng & support per 15min | 342,814 | $82.78 | $0.00 | $330.18 |
| H0036 | Comm psy face-face per 15min | 324,370 | $159.53 | $0.00 | $825.91 |
| V2020 | Vision svcs frames purchases | 306,583 | $32.09 | $0.00 | $101.77 |
| 97155 | Adapt behavior tx phys/qhp | 298,582 | $238.56 | $13.00 | $514.84 |
| 3008F | Body mass index docd | 295,699 | $0.00 | $0.00 | $0.71 |
| V2100 | Lens spher single plano 4.00 | 289,920 | $30.64 | $0.00 | $114.14 |
| 3074F | Syst bp lt 130 mm hg | 282,704 | $0.54 | $0.00 | $75.00 |