#4374 of 11K

10160

HCPCS Procedure Code

HCPCS code 10160 is the #4,374 most-billed Medicaid procedure code, with $627K in payments across 16K claims from 2018–2024. The national median cost per claim is $46.28. Costs vary widely — the 90th percentile is $225.63 per claim, 4.9× the median.

Total Paid

$627K

0.00% of all spending

Total Claims

16K

Providers

Avg Cost/Claim

$39

National Cost Distribution

How much do providers bill per claim for 10160? Based on 36 providers billing this code nationally.

Median

$46.28

Average

$68.62

Std Dev

$88.51

Max

$328.03

Percentile Distribution (Cost per Claim)

p10

$1.32

p25

$7.82

Median

$46.28

p75

$67.81

p90

$225.63

p95

$279.74

p99

$312.24

50% of providers bill between $7.82 and $67.81 per claim for this code.

90% bill between $1.32 and $225.63.

Top 1% bill above $312.24.

About This Procedure

HCPCS code 10160 was billed by 38 providers across 16K claims, totaling $627K in Medicaid payments from 2018–2024. This code was used for 13K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$46.28

Providers Billing

National Spending

$627K

Avg/Median Ratio

1.48×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 10160

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1013917665	$290K	$114.57	2.5× median	Above 75th
2	District Hospital Partners L P Washington, DC · Nurse Practitioner, Family	$61K	$282.92	6.1× median	Top 10%
3	Aurora Health Care Metro, Inc. Milwaukee, WI · Internal Medicine, Hematology & Oncology	$52K	$97.10	2.1× median	Above 75th
4	1023104023	$49K	$79.95	1.7× median	Above 75th
5	1750390142	$34K	$7.92	0.2× median	Below Median
6	1578956207	$20K	$19.47	0.4× median	Below Median
7	1740283324	$20K	$49.57	1.1× median	Above Median
8	1609981885	$15K	$7.52	0.2× median	Below Median
9	The Queens Medical Center Honolulu, HI · Psychiatric Unit	$13K	$278.68	6.0× median	Top 10%
10	Nationwide Children's Hospital Columbus, OH · General Acute Care Hospital	$11K	$328.03	7.1× median	Top 1%
11	1780053082	$8K	$63.76	1.4× median	Above Median
12	1487983656	$7K	$11.59	0.3× median	Below Median
13	1487397600	$7K	$51.11	1.1× median	Above Median
14	Montefiore Medical Center Bronx, NY · General Acute Care Hospital	$6K	$263.02	5.7× median	Top 10%
15	City Medical Of Upper East Side Pllc New York, NY · Clinic/Center Urgent Care	$5K	$9.09	0.2× median	Below Median
16	1679529978	$5K	$49.79	1.1× median	Above Median
17	1295053502	$4K	$6.00	0.1× median	Below Median
18	1225083595	$4K	$55.30	1.2× median	Above Median
19	Swedish Health Services Seattle, WA · General Acute Care Hospital	$3K	$188.23	4.1× median	Above 75th
20	1093756025	$3K	$42.98	0.9× median	Below Median

Showing top 20 of 38 providers billing this code

← All procedures Top providers →