#4415 of 11K

45331

HCPCS Procedure Code

HCPCS code 45331 is the #4,415 most-billed Medicaid procedure code, with $605K in payments across 4,146 claims from 2018–2024. The national median cost per claim is $162.70. Costs vary widely — the 90th percentile is $558.78 per claim, 3.4× the median.

Total Paid

$605K

0.00% of all spending

Total Claims

4,146

Providers

Avg Cost/Claim

$146

National Cost Distribution

How much do providers bill per claim for 45331? Based on 19 providers billing this code nationally.

Median

$162.70

Average

$278.75

Std Dev

$333.02

Max

$1,315.79

Percentile Distribution (Cost per Claim)

p10

$31.27

p25

$98.50

Median

$162.70

p75

$343.00

p90

$558.78

p95

$988.13

p99

$1,250.25

50% of providers bill between $98.50 and $343.00 per claim for this code.

90% bill between $31.27 and $558.78.

Top 1% bill above $1,250.25.

About This Procedure

HCPCS code 45331 was billed by 19 providers across 4,146 claims, totaling $605K in Medicaid payments from 2018–2024. This code was used for 4,048 unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$162.70

Providers Billing

National Spending

$605K

Avg/Median Ratio

1.71×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for 45331

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1457449621	$321K	$129.07	0.8× median	Below Median
2	1306068804	$98K	$215.12	1.3× median	Above Median
3	1134868045	$42K	$228.66	1.4× median	Above Median
4	1457458556	$29K	$405.29	2.5× median	Above 75th
5	The Cooper Health System Camden, NJ · General Acute Care Hospital	$16K	$1,315.79	8.1× median	Top 1%
6	1245352327	$16K	$109.19	0.7× median	Below Median
7	1578121919	$14K	$162.70	1.0× median	Above Median
8	The New York And Presbyterian Hospital New York, NY · General Acute Care Hospital	$12K	$951.72	5.8× median	Top 10%
9	1023055191	$12K	$96.86	0.6× median	Below Median
10	Regents Of The University Of Michigan Ann Arbor, MI · Clinic/Center, End-Stage Renal Disease (ESRD) Treatment	$9K	$324.66	2.0× median	Above Median
11	1225053523	$8K	$76.16	0.5× median	Below Median
12	Yale New Haven Hospital New Haven, CT · General Acute Care Hospital	$6K	$460.55	2.8× median	Above 75th
13	1679934145	$6K	$100.60	0.6× median	Below Median
14	1376774208	$4K	$361.34	2.2× median	Above 75th
15	1801827639	$4K	$32.66	0.2× median	Below Median
16	Phoenix Children's Hospital Phoenix, AZ · General Acute Care Hospital Children	$3K	$21.00	0.1× median	Below Median
17	1871930073	$2K	$178.96	1.1× median	Above Median
18	1295821825	$2K	$25.69	0.2× median	Below Median
19	1093765604	$1K	$100.14	0.6× median	Below Median

Showing top 19 of 19 providers billing this code

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