Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

#4541 of 11K

31653

HCPCS Procedure Code

HCPCS code 31653 is the #4,541 most-billed Medicaid procedure code, with $525K in payments across 423 claims from 2018–2024. The national median cost per claim is $165.40. Costs vary widely — the 90th percentile is $1,088.61 per claim, 6.6× the median.

Total Paid

$525K

0.00% of all spending

Total Claims

423

Providers

6

Avg Cost/Claim

$1K

National Cost Distribution

How much do providers bill per claim for 31653? Based on 5 providers billing this code nationally.

Median

$165.40

Average

$464.43

Std Dev

$649.42

Max

$1,619.43

Percentile Distribution (Cost per Claim)

p10
$121.01
p25
$129.84
Median
$165.40
p75
$292.38
p90
$1,088.61
p95
$1,354.02
p99
$1,566.34

50% of providers bill between $129.84 and $292.38 per claim for this code.

90% bill between $121.01 and $1,088.61.

Top 1% bill above $1,566.34.

About This Procedure

HCPCS code 31653 was billed by 6 providers across 423 claims, totaling $525K in Medicaid payments from 2018–2024. This code was used for 387 unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$165.40

Providers Billing

5

National Spending

$525K

Avg/Median Ratio

2.81×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for 31653

#ProviderTotal Paid
1Yale New Haven Hospital

New Haven, CT · General Acute Care Hospital

$502K
2Our Lady Of The Lake Physician Group Llc

Baton Rouge, LA · Allergy & Immunology

$18K
31730691775$2K
41619230802$2K
5Spectrum Health Primary Care Partners

Grand Rapids, MI · Psychologist, Clinical Child & Adolescent

$2K
6Our Lady Of The Lake Hospital Inc.

Baton Rouge, LA · General Acute Care Hospital

$0

Showing top 6 of 6 providers billing this code

Related Procedures