#1967 of 11K

64405

HCPCS Procedure Code

HCPCS code 64405 is the #1,967 most-billed Medicaid procedure code, with $10.8M in payments across 139K claims from 2018–2024. The national median cost per claim is $48.36. Costs vary widely — the 90th percentile is $173.09 per claim, 3.6× the median.

Total Paid

$10.8M

0.00% of all spending

Total Claims

139K

Providers

227

Avg Cost/Claim

$78

National Cost Distribution

How much do providers bill per claim for 64405? Based on 223 providers billing this code nationally.

Median

$48.36

Average

$75.09

Std Dev

$76.61

Max

$395.90

Percentile Distribution (Cost per Claim)

p10

$15.19

p25

$28.78

Median

$48.36

p75

$91.40

p90

$173.09

p95

$255.94

p99

$336.75

50% of providers bill between $28.78 and $91.40 per claim for this code.

90% bill between $15.19 and $173.09.

Top 1% bill above $336.75.

About This Procedure

HCPCS code 64405 was billed by 227 providers across 139K claims, totaling $10.8M in Medicaid payments from 2018–2024. This code was used for 116K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$48.36

Providers Billing

223

National Spending

$10.8M

Avg/Median Ratio

1.55×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for 64405

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Berkshire Medical Center, Inc Pittsfield, MA · General Acute Care Hospital	$3.1M	$253.46	5.2× median	Top 10%
2	1952402612	$578K	$51.91	1.1× median	Above Median
3	1033548581	$504K	$38.11	0.8× median	Below Median
4	Boston Medical Center Corporation Boston, MA · General Acute Care Hospital	$374K	$335.01	6.9× median	Top 10%
5	1457319485	$372K	$291.01	6.0× median	Top 10%
6	1548212939	$317K	$25.99	0.5× median	Below Median
7	The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital	$316K	$376.08	7.8× median	Top 1%
8	1740478502	$306K	$86.50	1.8× median	Above Median
9	Multicare Health System Tacoma, WA · Community/Behavioral Health	$231K	$194.55	4.0× median	Top 10%
10	Hartford Hospital Hartford, CT · General Acute Care Hospital	$223K	$220.58	4.6× median	Top 10%
11	1346411915	$219K	$50.08	1.0× median	Above Median
12	Regents Of The University Of Michigan Ann Arbor, MI · Clinic/Center, End-Stage Renal Disease (ESRD) Treatment	$203K	$111.97	2.3× median	Above 75th
13	1629004890	$166K	$83.86	1.7× median	Above Median
14	1639111057	$140K	$151.18	3.1× median	Above 75th
15	1982743001	$138K	$99.77	2.1× median	Above 75th
16	1336319086	$133K	$29.44	0.6× median	Below Median
17	1093158347	$132K	$37.45	0.8× median	Below Median
18	1477549756	$131K	$144.83	3.0× median	Above 75th
19	1639134414	$121K	$55.12	1.1× median	Above Median
20	University Of Rochester Rochester, NY · General Acute Care Hospital	$116K	$395.90	8.2× median	Top 1%

Showing top 20 of 227 providers billing this code

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