#1852 of 11K

78431

HCPCS Procedure Code

HCPCS code 78431 is the #1,852 most-billed Medicaid procedure code, with $12.7M in payments across 28K claims from 2018–2024. The national median cost per claim is $174.46. Costs vary widely — the 90th percentile is $903.29 per claim, 5.2× the median.

Total Paid

$12.7M

0.00% of all spending

Total Claims

28K

Providers

120

Avg Cost/Claim

$453

National Cost Distribution

How much do providers bill per claim for 78431? Based on 109 providers billing this code nationally.

Median

$174.46

Average

$375.67

Std Dev

$491.90

Max

$3,635.88

Percentile Distribution (Cost per Claim)

p10

$14.86

p25

$37.18

Median

$174.46

p75

$601.33

p90

$903.29

p95

$1,167.91

p99

$1,463.19

50% of providers bill between $37.18 and $601.33 per claim for this code.

90% bill between $14.86 and $903.29.

Top 1% bill above $1,463.19.

About This Procedure

HCPCS code 78431 was billed by 120 providers across 28K claims, totaling $12.7M in Medicaid payments from 2018–2024. This code was used for 25K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$174.46

Providers Billing

109

National Spending

$12.7M

Avg/Median Ratio

2.15×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for 78431

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1609907005	$1.3M	$1,415.77	8.1× median	Top 10%
2	Yale New Haven Hospital New Haven, CT · General Acute Care Hospital	$1.2M	$643.55	3.7× median	Above 75th
3	1356398713	$1.2M	$418.33	2.4× median	Above Median
4	1063851335	$835K	$460.22	2.6× median	Above Median
5	1043220650	$805K	$708.53	4.1× median	Above 75th
6	1770830606	$703K	$370.48	2.1× median	Above Median
7	1710909585	$525K	$506.53	2.9× median	Above Median
8	Hartford Hospital Hartford, CT · General Acute Care Hospital	$469K	$706.91	4.1× median	Above 75th
9	1043279565	$407K	$767.14	4.4× median	Above 75th
10	1366452880	$323K	$891.09	5.1× median	Above 75th
11	1194749580	$306K	$694.78	4.0× median	Above 75th
12	1255382545	$286K	$558.90	3.2× median	Above Median
13	Norton Hospitals, Inc Louisville, KY · General Acute Care Hospital	$259K	$1,206.98	6.9× median	Top 10%
14	Ohiohealth Corporation Columbus, OH · General Acute Care Hospital	$253K	$524.50	3.0× median	Above Median
15	Norton Hospitals Inc Louisville, KY · General Acute Care Hospital	$243K	$1,147.95	6.6× median	Top 10%
16	Carilion Medical Center Roanoke, VA · General Acute Care Hospital	$211K	$833.92	4.8× median	Above 75th
17	1306876065	$211K	$772.36	4.4× median	Above 75th
18	Trustees Of The University Of Pennsylvania Philadelphia, PA · Community/Behavioral Health	$210K	$929.84	5.3× median	Top 10%
19	Southern Ohio Medical Center Portsmouth, OH · Clinical Medical Laboratory	$202K	$544.96	3.1× median	Above Median
20	Mainehealth Portland, ME · Emergency Medicine	$186K	$601.33	3.4× median	Above Median

Showing top 20 of 120 providers billing this code

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