0421
HCPCS Procedure Code
HCPCS code 0421 is the #1,629 most-billed Medicaid procedure code, with $17.4M in payments across 156K claims from 2018–2024. The national median cost per claim is $28.39. Costs vary widely — the 90th percentile is $144.99 per claim, 5.1× the median.
Total Paid
$17.4M
0.00% of all spending
Total Claims
156K
Providers
177
Avg Cost/Claim
$111
National Cost Distribution
How much do providers bill per claim for 0421? Based on 58 providers billing this code nationally.
Median
$28.39
Average
$86.62
Std Dev
$210.13
Max
$1,575.50
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.83 and $124.02 per claim for this code.
90% bill between $0.22 and $144.99.
Top 1% bill above $817.01.
About This Procedure
HCPCS code 0421 was billed by 177 providers across 156K claims, totaling $17.4M in Medicaid payments from 2018–2024. This code was used for 52K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$28.39
Providers Billing
58
National Spending
$17.4M
Avg/Median Ratio
3.05×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for 0421
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1194899138 | $9.2M |
| 2 | 1629371398 | $2.4M |
| 3 | 1689715674 | $995K |
| 4 | 1275739047 | $925K |
| 5 | 1093801680 | $637K |
| 6 | 1962474387 | $473K |
| 7 | 1215014956 | $447K |
| 8 | 1225184963 | $417K |
| 9 | 1154387926 | $290K |
| 10 | 1821043332 | $264K |
| 11 | 1477560035 | $257K |
| 12 | 1487657235 | $219K |
| 13 | 1194812255 | $199K |
| 14 | 1184804825 | $169K |
| 15 | 1720251440 | $150K |
| 16 | 1578780185 | $84K |
| 17 | 1861491417 | $67K |
| 18 | 1861451841 | $52K |
| 19 | 1841291002 | $44K |
| 20 | 1710922471 | $28K |
Showing top 20 of 177 providers billing this code