Puerto Rico Medicaid Reimbursement Rates
What Medicaid pays for medical procedures and services in Puerto Rico, based on 2024 claims data.
2024 Overview
Procedures
1.6K
Total Claims
27.8M
Total Paid
$766.9M
Popular Services
Procedures
Showing 1–50 of 1,621 procedures, sorted by most claims.
| HCPCS Code | Description | Total Claims | Avg Payment | Min Payment | Max Payment |
|---|---|---|---|---|---|
| 99213 | Office o/p est low 20 min | 2,489,906 | $13.63 | $0.00 | $174.93 |
| 85025 | Complete cbc w/auto diff wbc | 950,841 | $7.39 | $0.00 | $10.73 |
| 3008F | Body mass index docd | 828,732 | $0.00 | $0.00 | $0.01 |
| 1159F | Med list docd in rcrd | 668,386 | $0.00 | $0.00 | $0.00 |
| 3078F | Diast bp <80 mm hg | 667,225 | $0.00 | $0.00 | $0.01 |
| 3074F | Syst bp lt 130 mm hg | 663,391 | $0.00 | $0.00 | $0.02 |
| 80053 | Comprehen metabolic panel | 663,193 | $10.70 | $0.00 | $14.86 |
| 80061 | Lipid panel | 646,565 | $13.41 | $0.00 | $19.20 |
| 1160F | Rvw meds by rx/dr in rcrd | 631,876 | $0.00 | $0.00 | $0.00 |
| D1999 | Unspecified preventive proc | 628,042 | $14.21 | $0.00 | $20.59 |
| 84443 | Assay thyroid stim hormone | 621,797 | $16.90 | $0.00 | $22.96 |
| 99212 | Office o/p est sf 10 min | 589,748 | $2.68 | $0.00 | $100.00 |
| 81000 | Urinalysis nonauto w/scope | 482,805 | $3.50 | $0.00 | $4.48 |
| 83036 | Hemoglobin glycosylated a1c | 385,672 | $9.52 | $0.00 | $13.75 |
| D1110 | Dental prophylaxis adult | 375,944 | $32.78 | $6.57 | $57.72 |
| 1126F | Amnt pain noted none prsnt | 368,826 | $0.00 | $0.00 | $0.00 |
| D0120 | Periodic oral evaluation | 364,921 | $15.69 | $0.00 | $28.21 |
| 92507 | Tx sp lang voice comm indiv | 356,881 | $60.47 | $0.00 | $97.50 |
| 36415 | Coll venous bld venipuncture | 315,844 | $3.83 | $0.00 | $9.00 |
| 81001 | Urinalysis auto w/scope | 260,767 | $3.03 | $0.00 | $3.93 |
| 99283 | Emergency dept visit low mdm | 241,419 | $56.41 | $0.00 | $87.60 |
| D0272 | Dental bitewings two images | 234,557 | $15.49 | $1.31 | $23.38 |
| 82306 | Vitamin d 25 hydroxy | 231,926 | $26.96 | $0.00 | $51.83 |
| 99214 | Office o/p est mod 30 min | 228,455 | $48.70 | $0.00 | $170.00 |
| 97110 | Therapeutic exercises | 223,028 | $24.57 | $0.00 | $56.70 |
| 2000F | Blood pressure measure | 194,727 | $0.00 | $0.00 | $0.00 |
| 97032 | Appl modality 1+estim ea 15 | 194,660 | $15.54 | $0.00 | $40.00 |
| 96127 | Brief emotional/behav assmt | 190,109 | $0.14 | $0.00 | $7.20 |
| 3079F | Diast bp 80-89 mm hg | 182,872 | $0.00 | $0.00 | $0.00 |
| 2001F | Weight record | 179,833 | $0.00 | $0.00 | $0.00 |
| 82043 | Ur albumin quantitative | 177,196 | $5.56 | $0.00 | $8.19 |
| D1208 | Topical app fluorid ex vrnsh | 174,414 | $14.50 | $0.46 | $15.14 |
| 2010F | Vital signs recorded | 165,856 | $0.00 | $0.00 | $0.00 |
| 96160 | Pt-focused hlth risk assmt | 165,709 | $10.92 | $0.00 | $45.00 |
| 84439 | Assay of free thyroxine | 158,059 | $8.82 | $0.00 | $12.48 |
| 87426 | Sarscov coronavirus ag ia | 157,303 | $40.39 | $0.00 | $45.23 |
| 1170F | Fxnl status assessed | 154,303 | $0.00 | $0.00 | $0.00 |
| 99203 | Office o/p new low 30 min | 139,640 | $72.32 | $0.00 | $121.58 |
| 1125F | Amnt pain noted pain prsnt | 138,260 | $0.00 | $0.00 | $0.00 |
| 1036F | Tobacco non-user | 132,141 | $0.00 | $0.00 | $0.00 |
| 71046 | X-ray exam chest 2 views | 128,699 | $14.16 | $0.00 | $34.74 |
| 82274 | Assay test for blood fecal | 128,472 | $15.25 | $0.00 | $22.09 |
| 97035 | App mdlty 1+ultrasound ea 15 | 125,836 | $13.82 | $0.00 | $27.59 |
| 71045 | X-ray exam chest 1 view | 123,483 | $9.53 | $0.00 | $29.26 |
| 3075F | Syst bp ge 130 - 139mm hg | 120,870 | $0.00 | $0.00 | $0.00 |
| 80048 | Basic metabolic pnl total ca | 117,247 | $8.33 | $0.00 | $11.69 |
| 82570 | Assay of urine creatinine | 115,869 | $4.86 | $0.00 | $7.33 |
| 99284 | Emergency dept visit mod mdm | 114,608 | $92.41 | $0.00 | $122.85 |
| 99232 | Sbsq hosp ip/obs moderate 35 | 112,593 | $71.82 | $0.00 | $512.15 |
| 87804 | Influenza assay w/optic | 111,698 | $14.97 | $0.00 | $33.10 |