43242
HCPCS Procedure Code
HCPCS code 43242 is the #6,498 most-billed Medicaid procedure code, with $61K in payments across 258 claims from 2018–2024. The national median cost per claim is $225.70. Costs vary widely — the 90th percentile is $879.13 per claim, 3.9× the median.
Total Paid
$61K
0.00% of all spending
Total Claims
258
Providers
9
Avg Cost/Claim
$235
National Cost Distribution
How much do providers bill per claim for 43242? Based on 9 providers billing this code nationally.
Median
$225.70
Average
$355.63
Std Dev
$354.79
Max
$1,063.72
Percentile Distribution (Cost per Claim)
50% of providers bill between $121.51 and $384.75 per claim for this code.
90% bill between $103.58 and $879.13.
Top 1% bill above $1,045.26.
About This Procedure
HCPCS code 43242 was billed by 9 providers across 258 claims, totaling $61K in Medicaid payments from 2018–2024. This code was used for 239 unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$225.70
Providers Billing
9
National Spending
$61K
Avg/Median Ratio
1.58×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for 43242
| # | Provider | Total Paid |
|---|---|---|
| 1 | Maimonides Medical Center Brooklyn, NY · General Acute Care Hospital | $13K |
| 2 | 1629242698 | $12K |
| 3 | Spectrum Health Hospitals Grand Rapids, MI · General Acute Care Hospital | $12K |
| 4 | University Of California Irvine Orange, CA · General Acute Care Hospital | $6K |
| 5 | 1144471715 | $5K |
| 6 | Spectrum Health Primary Care Partners Grand Rapids, MI · Psychologist, Clinical Child & Adolescent | $5K |
| 7 | 1902854078 | $4K |
| 8 | 1700287869 | $3K |
| 9 | 1538229984 | $732 |
Showing top 9 of 9 providers billing this code