42826
HCPCS Procedure Code
HCPCS code 42826 is the #5,376 most-billed Medicaid procedure code, with $216K in payments across 314 claims from 2018–2024. The national median cost per claim is $611.16. Costs vary widely — the 90th percentile is $1,276.68 per claim, 2.1× the median.
Total Paid
$216K
0.00% of all spending
Total Claims
314
Providers
11
Avg Cost/Claim
$686
National Cost Distribution
How much do providers bill per claim for 42826? Based on 11 providers billing this code nationally.
Median
$611.16
Average
$745.38
Std Dev
$400.79
Max
$1,361.70
Percentile Distribution (Cost per Claim)
50% of providers bill between $467.61 and $1,099.53 per claim for this code.
90% bill between $464.64 and $1,276.68.
Top 1% bill above $1,353.20.
About This Procedure
HCPCS code 42826 was billed by 11 providers across 314 claims, totaling $216K in Medicaid payments from 2018–2024. This code was used for 294 unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$611.16
Providers Billing
11
National Spending
$216K
Avg/Median Ratio
1.22×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 42826
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1306843222 | $66K |
| 2 | 1275892481 | $50K |
| 3 | 1063514107 | $17K |
| 4 | 1134178999 | $17K |
| 5 | 1295071520 | $15K |
| 6 | 1497759955 | $12K |
| 7 | 1992706899 | $11K |
| 8 | 1093795031 | $10K |
| 9 | 1598996894 | $7K |
| 10 | Boston Medical Center Corporation Boston, MA · General Acute Care Hospital | $6K |
| 11 | 1689623506 | $4K |
Showing top 11 of 11 providers billing this code