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 51–100 of 2,827 procedures, sorted by most claims.
| HCPCS Code | Description | Total Claims | Avg Payment | Min Payment | Max Payment |
|---|---|---|---|---|---|
| G0480 | Drug test def 1-7 classes | 281,453 | $56.34 | $0.00 | $94.07 |
| 99309 | Sbsq nf care moderate mdm 30 | 268,385 | $29.99 | $0.00 | $120.38 |
| D0150 | Comprehensve oral evaluation | 266,852 | $22.63 | $0.00 | $132.00 |
| V2784 | Lens polycarb or equal | 264,722 | $12.03 | $0.00 | $62.43 |
| 99232 | Sbsq hosp ip/obs moderate 35 | 261,409 | $50.33 | $0.00 | $143.43 |
| T1016 | Case management | 260,714 | $95.21 | $0.00 | $667.98 |
| H2019 | Ther behav svc, per 15 min | 258,132 | $121.84 | $0.00 | $460.02 |
| 97112 | Neuromuscular reeducation | 257,867 | $23.89 | $0.00 | $396.68 |
| 71046 | X-ray exam chest 2 views | 254,012 | $11.85 | $0.00 | $124.69 |
| 80061 | Lipid panel | 246,627 | $9.34 | $0.00 | $54.58 |
| T1019 | Personal care ser per 15 min | 246,368 | $86.16 | $6.03 | $211.50 |
| D0272 | Dental bitewings two images | 242,202 | $18.32 | $0.00 | $113.19 |
| H0038 | Self-help/peer svc per 15min | 236,660 | $175.87 | $0.00 | $403.51 |
| 3078F | Diast bp <80 mm hg | 236,094 | $0.64 | $0.00 | $69.64 |
| D0230 | Intraoral periapical ea add | 234,873 | $9.87 | $0.00 | $104.49 |
| D2392 | Post 2 srfc resinbased cmpst | 231,188 | $71.27 | $0.00 | $500.68 |
| G2211 | Complex e/m visit add on | 228,449 | $7.86 | $0.00 | $65.62 |
| 99212 | Office o/p est sf 10 min | 223,298 | $42.73 | $0.00 | $196.25 |
| G9012 | Other specified case mgmt | 223,098 | $263.06 | $0.00 | $541.00 |
| S5126 | Attendant care service /diem | 220,974 | $87.37 | $85.71 | $90.01 |
| D7140 | Extraction erupted tooth/exr | 205,677 | $71.54 | $0.00 | $2,249.09 |
| T1002 | Rn services up to 15 minutes | 200,913 | $477.02 | $0.00 | $7,794.38 |
| A0429 | Bls-emergency | 199,348 | $412.88 | $34.10 | $689.79 |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or | 199,108 | $71.38 | $5.57 | $370.02 |
| 92551 | Pure tone hearing test air | 190,805 | $6.03 | $0.00 | $25.00 |
| A4927 | Non-sterile gloves | 189,515 | $15.41 | $0.51 | $54.86 |
| J2405 | Ondansetron hcl injection | 188,359 | $0.08 | $0.00 | $19.91 |
| 90999 | Unlisted dialysis procedure | 186,218 | $137.21 | $27.06 | $349.23 |
| J1885 | Ketorolac tromethamine inj | 185,938 | $0.13 | $0.00 | $174.46 |
| 93005 | Electrocardiogram tracing | 178,433 | $10.99 | $0.00 | $155.29 |
| H0015 | Alcohol and/or drug services | 173,987 | $130.53 | $0.00 | $405.00 |
| 83036 | Hemoglobin glycosylated a1c | 172,704 | $5.32 | $0.00 | $49.27 |
| 96127 | Brief emotional/behav assmt | 168,361 | $10.99 | $0.00 | $126.35 |
| 92014 | Compre oph exam est pt 1/> | 167,878 | $43.45 | $0.00 | $267.38 |
| 80048 | Basic metabolic pnl total ca | 166,075 | $6.16 | $0.00 | $292.91 |
| 99173 | Visual acuity screen | 163,912 | $3.12 | $0.00 | $25.12 |
| H0046 | Mental health service, nos | 162,895 | $204.24 | $0.00 | $1,764.10 |
| 99392 | Prev visit est age 1-4 | 162,379 | $80.96 | $0.00 | $208.42 |
| 97140 | Manual therapy 1/> regions | 162,357 | $19.69 | $0.00 | $270.47 |
| 99215 | Office o/p est hi 40 min | 158,014 | $94.52 | $0.00 | $457.50 |
| S9088 | Services provided in urgent | 157,935 | $31.36 | $0.00 | $37.50 |
| D0603 | Caries risk assess high risk | 155,082 | $8.23 | $0.00 | $15.00 |
| 92015 | Determine refractive state | 153,690 | $6.88 | $0.00 | $77.46 |
| T4541 | Large disposable underpad | 153,302 | $21.70 | $2.00 | $104.55 |
| 81001 | Urinalysis auto w/scope | 150,643 | $2.22 | $0.00 | $58.84 |
| 84443 | Assay thyroid stim hormone | 150,073 | $13.16 | $0.00 | $78.87 |
| 80305 | Drug test prsmv dir opt obs | 149,686 | $15.08 | $0.00 | $55.66 |
| D0330 | Panoramic image | 148,102 | $35.31 | $0.00 | $150.00 |
| 87491 | Chlmyd trach dna amp probe | 145,683 | $21.35 | $0.00 | $258.05 |
| 99203 | Office o/p new low 30 min | 145,275 | $62.87 | $0.00 | $217.88 |