#4283 of 11K

54160

HCPCS Procedure Code

HCPCS code 54160 is the #4,283 most-billed Medicaid procedure code, with $695K in payments across 5K claims from 2018–2024. The national median cost per claim is $131.16.

Total Paid

$695K

0.00% of all spending

Total Claims

Providers

Avg Cost/Claim

$136

National Cost Distribution

How much do providers bill per claim for 54160? Based on 52 providers billing this code nationally.

Median

$131.16

Average

$162.69

Std Dev

$146.10

Max

$937.08

Percentile Distribution (Cost per Claim)

p10

$82.51

p25

$106.89

Median

$131.16

p75

$164.95

p90

$199.35

p95

$279.97

p99

$837.33

50% of providers bill between $106.89 and $164.95 per claim for this code.

90% bill between $82.51 and $199.35.

Top 1% bill above $837.33.

About This Procedure

HCPCS code 54160 was billed by 53 providers across 5K claims, totaling $695K in Medicaid payments from 2018–2024. This code was used for 5K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$131.16

Providers Billing

National Spending

$695K

Avg/Median Ratio

1.24×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 54160

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1598076226	$113K	$127.35	1.0× median	Below Median
2	1285662239	$100K	$937.08	7.1× median	Top 1%
3	1295110146	$61K	$98.99	0.8× median	Below Median
4	1275579658	$53K	$98.88	0.8× median	Below Median
5	1104951904	$35K	$184.29	1.4× median	Above 75th
6	1396713616	$28K	$119.77	0.9× median	Below Median
7	1578832242	$26K	$153.95	1.2× median	Above Median
8	1720189137	$24K	$163.60	1.2× median	Above Median
9	1164557856	$22K	$123.64	0.9× median	Below Median
10	1427189547	$19K	$33.47	0.3× median	Below Median
11	1659780526	$18K	$129.38	1.0× median	Below Median
12	1821186313	$16K	$741.50	5.7× median	Top 10%
13	1568570562	$15K	$161.09	1.2× median	Above Median
14	1235297847	$14K	$156.57	1.2× median	Above Median
15	1770581233	$13K	$108.54	0.8× median	Below Median
16	1992701429	$12K	$304.69	2.3× median	Top 10%
17	1811324882	$9K	$186.38	1.4× median	Above 75th
18	1235455544	$8K	$259.74	2.0× median	Top 10%
19	1952703373	$7K	$175.97	1.3× median	Above 75th
20	1245526987	$7K	$174.09	1.3× median	Above 75th

Showing top 20 of 53 providers billing this code

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54161$74.0M 54150$36.2M 54163$1.2M 54162$397K 54164$10K

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