0255
HCPCS Procedure Code
HCPCS code 0255 is the #6,120 most-billed Medicaid procedure code, with $93K in payments across 13K claims from 2018–2024. The national median cost per claim is $5.73. Costs vary widely — the 90th percentile is $32.07 per claim, 5.6× the median.
Total Paid
$93K
0.00% of all spending
Total Claims
13K
Providers
48
Avg Cost/Claim
$7
National Cost Distribution
How much do providers bill per claim for 0255? Based on 30 providers billing this code nationally.
Median
$5.73
Average
$13.31
Std Dev
$20.15
Max
$80.39
Percentile Distribution (Cost per Claim)
50% of providers bill between $3.19 and $11.92 per claim for this code.
90% bill between $0.45 and $32.07.
Top 1% bill above $76.98.
About This Procedure
HCPCS code 0255 was billed by 48 providers across 13K claims, totaling $93K in Medicaid payments from 2018–2024. This code was used for 12K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$5.73
Providers Billing
30
National Spending
$93K
Avg/Median Ratio
2.32×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for 0255
| # | Provider | Total Paid |
|---|---|---|
| 1 | Palomar Health Escondido, CA · General Acute Care Hospital | $26K |
| 2 | Keck Medical Center Of Usc Los Angeles, CA · General Acute Care Hospital | $17K |
| 3 | 1417901091 | $7K |
| 4 | 1336279959 | $6K |
| 5 | 1184654923 | $6K |
| 6 | 1063412005 | $5K |
| 7 | 1336328244 | $4K |
| 8 | 1134274897 | $4K |
| 9 | 1295880912 | $4K |
| 10 | Kaiser Foundation Hospitals Downey, CA · General Acute Care Hospital | $4K |
| 11 | 1306991211 | $2K |
| 12 | 1376513754 | $2K |
| 13 | Kaiser Foundation Health Plan Inc Oakland, CA · Health Maintenance Organization | $1K |
| 14 | 1952546616 | $1K |
| 15 | 1356496772 | $558 |
| 16 | 1013062769 | $532 |
| 17 | 1639523004 | $497 |
| 18 | 1376698043 | $456 |
| 19 | County Of Ventura Ventura, CA · Clinic/Center, Emergency Care | $425 |
| 20 | 1528263746 | $395 |
Showing top 20 of 48 providers billing this code