#3353 of 11K

55175

HCPCS Procedure Code

HCPCS code 55175 is the #3,353 most-billed Medicaid procedure code, with $1.9M in payments across 4,120 claims from 2018–2024. The national median cost per claim is $198.01. Costs vary widely — the 90th percentile is $1,143.41 per claim, 5.8× the median.

Total Paid

$1.9M

0.00% of all spending

Total Claims

4,120

Providers

Avg Cost/Claim

$452

National Cost Distribution

How much do providers bill per claim for 55175? Based on 12 providers billing this code nationally.

Median

$198.01

Average

$428.23

Std Dev

$483.58

Max

$1,557.89

Percentile Distribution (Cost per Claim)

p10

$111.79

p25

$113.71

Median

$198.01

p75

$498.04

p90

$1,143.41

p95

$1,355.82

p99

$1,517.48

50% of providers bill between $113.71 and $498.04 per claim for this code.

90% bill between $111.79 and $1,143.41.

Top 1% bill above $1,517.48.

About This Procedure

HCPCS code 55175 was billed by 13 providers across 4,120 claims, totaling $1.9M in Medicaid payments from 2018–2024. This code was used for 3,521 unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$198.01

Providers Billing

National Spending

$1.9M

Avg/Median Ratio

2.16×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for 55175

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Seattle Children's Hospital Seattle, WA · Prosthetic/Orthotic Supplier	$712K	$1,557.89	7.9× median	Top 1%
2	1427098169	$679K	$1,190.49	6.0× median	Top 10%
3	Norton Hospitals, Inc Louisville, KY · General Acute Care Hospital	$133K	$286.67	1.4× median	Above Median
4	Norton Hospitals Inc Louisville, KY · General Acute Care Hospital	$103K	$252.95	1.3× median	Above Median
5	Ochsner Clinic Llc New Orleans, LA · Surgery	$60K	$114.29	0.6× median	Below Median
6	1154612166	$60K	$143.07	0.7× median	Below Median
7	North Carolina Baptist Hospital Winston Salem, NC · General Acute Care Hospital	$50K	$719.64	3.6× median	Above 75th
8	1326695255	$31K	$111.95	0.6× median	Below Median
9	Wake Forest University Health Sciences Winston Salem, NC · Clinic/Center, Multi-Specialty	$28K	$130.13	0.7× median	Below Median
10	Phoenix Children's Hospital Phoenix, AZ · General Acute Care Hospital Children	$5K	$424.18	2.1× median	Above Median
11	1578769006	$2K	$111.77	0.6× median	Below Median
12	1265530653	$1K	$95.72	0.5× median	Below Median
13	Ochsner Clinic Foundation New Orleans, LA · General Acute Care Hospital	$0	$0.00	0.0× median	Below Median

Showing top 13 of 13 providers billing this code

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