#2149 of 11K

54640

HCPCS Procedure Code

HCPCS code 54640 is the #2,149 most-billed Medicaid procedure code, with $8.4M in payments across 6,532 claims from 2018–2024. The national median cost per claim is $886.80. Costs vary widely — the 90th percentile is $1,979.61 per claim, 2.2× the median.

Total Paid

$8.4M

0.00% of all spending

Total Claims

6,532

Providers

Avg Cost/Claim

$1K

National Cost Distribution

How much do providers bill per claim for 54640? Based on 69 providers billing this code nationally.

Median

$886.80

Average

$969.26

Std Dev

$715.75

Max

$2,591.44

Percentile Distribution (Cost per Claim)

p10

$224.57

p25

$321.94

Median

$886.80

p75

$1,521.56

p90

$1,979.61

p95

$2,292.06

p99

$2,556.01

50% of providers bill between $321.94 and $1,521.56 per claim for this code.

90% bill between $224.57 and $1,979.61.

Top 1% bill above $2,556.01.

About This Procedure

HCPCS code 54640 was billed by 69 providers across 6,532 claims, totaling $8.4M in Medicaid payments from 2018–2024. This code was used for 6,032 unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$886.80

Providers Billing

National Spending

$8.4M

Avg/Median Ratio

1.09×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 54640

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Phoenix Children's Hospital Phoenix, AZ · General Acute Care Hospital Children	$2.9M	$2,591.44	2.9× median	Top 1%
2	Scottish Rite Children's Medical Center Atlanta, GA · Pediatrics Pediatric Hematology-Oncology	$1.3M	$1,350.88	1.5× median	Above Median
3	Vhs Childrens Hospital Of Michigan Inc Detroit, MI · Clinic/Center, Ambulatory Surgical	$498K	$1,521.56	1.7× median	Above Median
4	State Of Mississippi - University Of Mississippi Medical Center Jackson, MS · General Acute Care Hospital	$384K	$1,951.09	2.2× median	Above 75th
5	Nationwide Children's Hospital Columbus, OH · General Acute Care Hospital	$371K	$1,970.96	2.2× median	Above 75th
6	Children's Hospital Corporation Boston, MA · Clinic/Center	$324K	$1,654.75	1.9× median	Above 75th
7	Seattle Children's Hospital Seattle, WA · Prosthetic/Orthotic Supplier	$286K	$1,373.58	1.5× median	Above Median
8	Connecticut Children's Medical Center Hartford, CT · General Acute Care Hospital, Children	$170K	$2,539.34	2.9× median	Top 10%
9	Suny Health Science Center At Syracuse Syracuse, NY · General Acute Care Hospital	$155K	$1,028.51	1.2× median	Above Median
10	Egleston Children's Hospital At Emory University Inc. Atlanta, GA · Pediatrics Pediatric Emergency Medicine	$154K	$1,297.59	1.5× median	Above Median
11	Norton Hospitals, Inc Louisville, KY · General Acute Care Hospital	$144K	$732.79	0.8× median	Below Median
12	Robert Wood Johnson University Hospital, Inc New Brunswick, NJ · General Acute Care Hospital	$133K	$1,343.06	1.5× median	Above Median
13	Norton Hospitals Inc Louisville, KY · General Acute Care Hospital	$125K	$1,298.35	1.5× median	Above Median
14	University Of Kentucky Lexington, KY · General Acute Care Hospital	$108K	$1,583.81	1.8× median	Above 75th
15	The Nemours Foundation Orlando, FL · General Acute Care Hospital Children	$107K	$1,571.40	1.8× median	Above 75th
16	1306952726	$100K	$1,451.20	1.6× median	Above Median
17	1366422834	$97K	$1,063.14	1.2× median	Above Median
18	Seventh-day Adventists Loma Linda University Medical Center Loma Linda, CA · General Acute Care Hospital	$96K	$317.99	0.4× median	Below Median
19	Unm Hospital Albuquerque, NM · General Acute Care Hospital	$88K	$2,263.57	2.6× median	Top 10%
20	1295900439	$76K	$451.71	0.5× median	Below Median

Showing top 20 of 69 providers billing this code

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