42821
HCPCS Procedure Code
HCPCS code 42821 is the #3,028 most-billed Medicaid procedure code, with $2.7M in payments across 3K claims from 2018–2024. The national median cost per claim is $613.18. Costs vary widely — the 90th percentile is $1,765.48 per claim, 2.9× the median.
Total Paid
$2.7M
0.00% of all spending
Total Claims
3K
Providers
46
Avg Cost/Claim
$1K
National Cost Distribution
How much do providers bill per claim for 42821? Based on 45 providers billing this code nationally.
Median
$613.18
Average
$853.67
Std Dev
$673.35
Max
$2,259.09
Percentile Distribution (Cost per Claim)
50% of providers bill between $252.32 and $1,398.74 per claim for this code.
90% bill between $133.70 and $1,765.48.
Top 1% bill above $2,211.27.
About This Procedure
HCPCS code 42821 was billed by 46 providers across 3K claims, totaling $2.7M in Medicaid payments from 2018–2024. This code was used for 2K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$613.18
Providers Billing
45
National Spending
$2.7M
Avg/Median Ratio
1.39×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 42821
| # | Provider | Total Paid |
|---|---|---|
| 1 | Children's Hospital Medical Center Cincinnati, OH · Clinic/Center, Primary Care | $414K |
| 2 | Phoenix Children's Hospital Phoenix, AZ · General Acute Care Hospital Children | $375K |
| 3 | Nationwide Children's Hospital Columbus, OH · General Acute Care Hospital | $285K |
| 4 | Dayton Children's Hospital Dayton, OH · General Acute Care Hospital, Children | $255K |
| 5 | State Of Mississippi - University Of Mississippi Medical Center Jackson, MS · General Acute Care Hospital | $193K |
| 6 | Vhs Childrens Hospital Of Michigan Inc Detroit, MI · Clinic/Center, Ambulatory Surgical | $162K |
| 7 | 1306843222 | $157K |
| 8 | 1306952726 | $109K |
| 9 | Scottish Rite Children's Medical Center Atlanta, GA · Pediatrics Pediatric Hematology-Oncology | $103K |
| 10 | University Of Kentucky Lexington, KY · General Acute Care Hospital | $94K |
| 11 | Children's Hospital Medical Center Of Akron Akron, OH · General Acute Care Hospital Children | $88K |
| 12 | 1235240813 | $87K |
| 13 | Arkansas Childrens Hospital Little Rock, AR · Clinic/Center, Critical Access Hospital | $38K |
| 14 | Spectrum Health Hospitals Grand Rapids, MI · General Acute Care Hospital | $34K |
| 15 | 1073827101 | $29K |
| 16 | 1477617751 | $27K |
| 17 | 1033120423 | $27K |
| 18 | 1649794157 | $23K |
| 19 | Yale New Haven Hospital New Haven, CT · General Acute Care Hospital | $22K |
| 20 | 1770586794 | $21K |
Showing top 20 of 46 providers billing this code