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#5029 of 11K

0430

HCPCS Procedure Code

HCPCS code 0430 is the #5,029 most-billed Medicaid procedure code, with $316K in payments across 29K claims from 2018–2024. The national median cost per claim is $21.43. Costs vary widely — the 90th percentile is $159.83 per claim, 7.5× the median.

Total Paid

$316K

0.00% of all spending

Total Claims

29K

Providers

61

Avg Cost/Claim

$11

National Cost Distribution

How much do providers bill per claim for 0430? Based on 27 providers billing this code nationally.

Median

$21.43

Average

$118.00

Std Dev

$350.32

Max

$1,802.88

Percentile Distribution (Cost per Claim)

p10
$0.28
p25
$5.24
Median
$21.43
p75
$57.63
p90
$159.83
p95
$397.24
p99
$1,455.43

50% of providers bill between $5.24 and $57.63 per claim for this code.

90% bill between $0.28 and $159.83.

Top 1% bill above $1,455.43.

About This Procedure

HCPCS code 0430 was billed by 61 providers across 29K claims, totaling $316K in Medicaid payments from 2018–2024. This code was used for 17K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$21.43

Providers Billing

27

National Spending

$316K

Avg/Median Ratio

5.51×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for 0430

#ProviderTotal Paid
11447817721$120K
21477596583$47K
31972201598$38K
4County Of Ventura

Ventura, CA · Clinic/Center, Emergency Care

$26K
5Palomar Health

Escondido, CA · General Acute Care Hospital

$17K
61225038136$15K
71558915256$9K
81508959214$8K
91487681631$7K
10University Of California Irvine

Orange, CA · General Acute Care Hospital

$6K
111154453579$5K
121194840421$3K
131215927470$3K
141922522507$3K
15Grossmont Hospital Corporation

La Mesa, CA · General Acute Care Hospital

$2K
161104906569$2K
171831188275$1K
181760510937$886
19Central Valley Specialty Hospital Inc

Modesto, CA · General Acute Care Hospital

$456
201477555472$382

Showing top 20 of 61 providers billing this code