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 101–150 of 1,621 procedures, sorted by most claims.
| HCPCS Code | Description | Total Claims | Avg Payment | Min Payment | Max Payment |
|---|---|---|---|---|---|
| 99051 | Med serv eve/wkend/holiday | 55,018 | $54.98 | $0.00 | $150.00 |
| 86701 | Hiv-1antibody | 54,951 | $8.89 | $0.00 | $12.12 |
| 1157F | Advnc care plan in rcrd | 54,263 | $0.00 | $0.00 | $0.00 |
| 97530 | Therapeutic activities | 54,225 | $41.02 | $0.45 | $101.21 |
| 92002 | Intrm oph exam new patient | 53,231 | $64.13 | $0.00 | $87.10 |
| 3048F | Ldl-c <100 mg/dl | 52,705 | $0.00 | $0.00 | $0.00 |
| 99401 | Prev med cnsl indiv apprx 15 | 51,646 | $0.04 | $0.00 | $10.27 |
| 99070 | Special supplies phys/qhp | 51,272 | $35.64 | $0.00 | $602.00 |
| 87275 | Influenza b ag if | 50,934 | $11.75 | $0.98 | $13.35 |
| 87590 | N.gonorrhoeae dna dir prob | 48,657 | $22.07 | $0.00 | $32.00 |
| 99238 | Hosp ip/obs dschrg mgmt 30/< | 47,582 | $41.93 | $0.00 | $209.48 |
| 76700 | Us exam abdom complete | 47,385 | $66.37 | $0.00 | $189.37 |
| 87086 | Urine culture/colony count | 46,120 | $7.57 | $0.00 | $11.43 |
| 93306 | Tte w/doppler complete | 45,646 | $231.48 | $0.00 | $318.93 |
| 87490 | Chlmyd trach dna dir probe | 45,586 | $22.73 | $0.00 | $32.00 |
| 99234 | Hosp ip/obs sm dt sf/low 45 | 44,956 | $93.73 | $12.37 | $120.55 |
| 85651 | Rbc sed rate nonautomated | 44,568 | $3.62 | $0.00 | $4.86 |
| 87389 | Hiv-1 ag w/hiv-1&-2 ab ag ia | 44,107 | $22.29 | $0.00 | $26.24 |
| 86803 | Hepatitis c ab test | 41,890 | $14.05 | $0.00 | $20.22 |
| A0429 | Bls-emergency | 41,778 | $260.37 | $0.00 | $330.05 |
| 99396 | Prev visit est age 40-64 | 41,338 | $0.05 | $0.00 | $89.69 |
| 74176 | Ct abd & pelvis w/o contrast | 41,048 | $131.71 | $0.00 | $399.58 |
| 70450 | Ct head/brain w/o dye | 41,004 | $67.45 | $0.00 | $220.00 |
| D2150 | Amalgam two surfaces permane | 40,536 | $47.39 | $17.07 | $49.96 |
| S9097 | Home visit wound care | 39,961 | $64.47 | $0.00 | $85.00 |
| Q0084 | Chemotherapy by infusion | 39,945 | $93.43 | $0.00 | $362.43 |
| 1033F | Tobacco nonsmoker nor 2ndhnd | 38,611 | $0.00 | $0.00 | $0.00 |
| 4010F | Ace/arb therapy rxd/taken | 38,225 | $0.00 | $0.00 | $0.00 |
| 90834 | Psytx w pt 45 minutes | 37,791 | $3.03 | $0.00 | $102.91 |
| 86703 | Hiv-1/hiv-2 1 result antbdy | 37,721 | $11.07 | $0.00 | $14.91 |
| 99394 | Prev visit est age 12-17 | 37,445 | $0.04 | $0.00 | $17.89 |
| 99392 | Prev visit est age 1-4 | 37,102 | $0.11 | $0.00 | $43.06 |
| S9083 | Urgent care center global | 36,781 | $42.24 | $0.00 | $100.00 |
| 99222 | 1st hosp ip/obs moderate 55 | 35,490 | $98.47 | $0.00 | $135.50 |
| 1220F | Pt screened for depression | 34,869 | $0.00 | $0.00 | $0.00 |
| 76830 | Transvaginal us non-ob | 34,696 | $71.96 | $0.00 | $125.42 |
| 77066 | Dx mammo incl cad bi | 34,003 | $111.67 | $0.00 | $166.20 |
| 85610 | Prothrombin time | 33,997 | $3.83 | $0.00 | $5.38 |
| A9276 | Disposable sensor, cgm sys | 33,880 | $534.40 | $155.18 | $3,932.56 |
| 90460 | Im admin 1st/only component | 33,665 | $4.23 | $0.00 | $49.62 |
| 99050 | Medical services after hrs | 33,006 | $12.28 | $0.00 | $50.00 |
| 4035F | Influenza imm rec | 32,485 | $0.00 | $0.00 | $0.09 |
| 85730 | Thromboplastin time partial | 32,414 | $5.64 | $0.00 | $8.18 |
| 92250 | Fundus photography w/i&r | 32,405 | $31.94 | $0.00 | $113.70 |
| 3017F | Colorectal ca screen doc rev | 32,212 | $0.00 | $0.00 | $0.00 |
| 72100 | X-ray exam l-s spine 2/3 vws | 31,115 | $22.27 | $0.00 | $41.43 |
| 99235 | Hosp ip/obs same date mod 70 | 30,697 | $127.39 | $0.00 | $160.66 |
| 80074 | Acute hepatitis panel | 30,456 | $46.80 | $0.00 | $66.25 |
| 99282 | Emergency dept visit sf mdm | 30,121 | $31.30 | $0.00 | $42.02 |
| 92134 | Cptrz oph dx img pst sgm rta | 29,991 | $33.51 | $8.97 | $124.11 |