#1209 of 11K

76942

HCPCS Procedure Code

HCPCS code 76942 is the #1,209 most-billed Medicaid procedure code, with $33.3M in payments across 925K claims from 2018–2024. The national median cost per claim is $24.73. Costs vary widely — the 90th percentile is $67.54 per claim, 2.7× the median.

Total Paid

$33.3M

0.00% of all spending

Total Claims

925K

Providers

Avg Cost/Claim

$36

National Cost Distribution

How much do providers bill per claim for 76942? Based on 2K providers billing this code nationally.

Median

$24.73

Average

$35.06

Std Dev

$37.41

Max

$490.41

Percentile Distribution (Cost per Claim)

p10

$5.97

p25

$13.78

Median

$24.73

p75

$45.67

p90

$67.54

p95

$98.61

p99

$182.01

50% of providers bill between $13.78 and $45.67 per claim for this code.

90% bill between $5.97 and $67.54.

Top 1% bill above $182.01.

About This Procedure

HCPCS code 76942 was billed by 2K providers across 925K claims, totaling $33.3M in Medicaid payments from 2018–2024. This code was used for 761K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$24.73

Providers Billing

National Spending

$33.3M

Avg/Median Ratio

1.42×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 76942

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Ahava Medical And Rehabilitation Center, Llc Brooklyn, NY · Rehabilitation Practitioner	$1.5M	$153.23	6.2× median	Top 10%
2	1720282585	$907K	$50.79	2.1× median	Above 75th
3	1154636397	$902K	$29.72	1.2× median	Above Median
4	1093819419	$625K	$59.21	2.4× median	Above 75th
5	1154376788	$618K	$61.11	2.5× median	Above 75th
6	Baystate Medical Center Inc Springfield, MA · General Acute Care Hospital	$413K	$46.95	1.9× median	Above 75th
7	1487102208	$385K	$57.52	2.3× median	Above 75th
8	Virginia Commonwealth University Health System Authority Richmond, VA · General Acute Care Hospital	$351K	$72.67	2.9× median	Top 10%
9	Owensboro Health Inc Owensboro, KY · General Acute Care Hospital	$332K	$167.14	6.8× median	Top 10%
10	University Of Kentucky Lexington, KY · General Acute Care Hospital	$329K	$155.56	6.3× median	Top 10%
11	1487703401	$325K	$98.19	4.0× median	Top 10%
12	1265727762	$318K	$52.98	2.1× median	Above 75th
13	1457685398	$285K	$67.12	2.7× median	Above 75th
14	1013954999	$268K	$54.67	2.2× median	Above 75th
15	1255683785	$268K	$63.16	2.6× median	Above 75th
16	The General Hospital Corporation Boston, MA · General Acute Care Hospital	$268K	$59.55	2.4× median	Above 75th
17	1033497714	$265K	$21.60	0.9× median	Below Median
18	1427165596	$253K	$73.38	3.0× median	Top 10%
19	1558314427	$250K	$29.62	1.2× median	Above Median
20	1295053502	$250K	$31.48	1.3× median	Above Median

Showing top 20 of 2K providers billing this code

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