85055
HCPCS Procedure Code
HCPCS code 85055 is the #3,183 most-billed Medicaid procedure code, with $2.3M in payments across 246K claims from 2018–2024. The national median cost per claim is $10.54. Costs vary widely — the 90th percentile is $32.47 per claim, 3.1× the median.
Total Paid
$2.3M
0.00% of all spending
Total Claims
246K
Providers
148
Avg Cost/Claim
$9
National Cost Distribution
How much do providers bill per claim for 85055? Based on 141 providers billing this code nationally.
Median
$10.54
Average
$13.96
Std Dev
$12.89
Max
$70.68
Percentile Distribution (Cost per Claim)
50% of providers bill between $3.91 and $21.35 per claim for this code.
90% bill between $0.26 and $32.47.
Top 1% bill above $49.49.
About This Procedure
HCPCS code 85055 was billed by 148 providers across 246K claims, totaling $2.3M in Medicaid payments from 2018–2024. This code was used for 158K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$10.54
Providers Billing
141
National Spending
$2.3M
Avg/Median Ratio
1.32×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 85055
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1205935012 | $383K |
| 2 | The New York And Presbyterian Hospital New York, NY · General Acute Care Hospital | $260K |
| 3 | 1982784534 | $110K |
| 4 | Regents Of The University Of Michigan Ann Arbor, MI · Clinic/Center, End-Stage Renal Disease (ESRD) Treatment | $100K |
| 5 | 1255875746 | $90K |
| 6 | 1679518724 | $78K |
| 7 | 1609875772 | $76K |
| 8 | Ahs Hospital Corp. Morristown, NJ · General Acute Care Hospital | $73K |
| 9 | University Of Texas Medical Branch At Galveston Galveston, TX · Clinic/Center, Ambulatory Surgical | $64K |
| 10 | Newyork-presbyterian-queens Flushing, NY · General Acute Care Hospital | $59K |
| 11 | Children's Hospital Corporation Boston, MA · Clinic/Center | $54K |
| 12 | Yale New Haven Hospital New Haven, CT · General Acute Care Hospital | $47K |
| 13 | 1528024718 | $45K |
| 14 | Mercy Health - St Vincent Medical Center Llc Toledo, OH · Ambulance, Land Transport | $44K |
| 15 | 1497773337 | $34K |
| 16 | Spectrum Health Hospitals Grand Rapids, MI · General Acute Care Hospital | $32K |
| 17 | Phoenix Children's Hospital Phoenix, AZ · General Acute Care Hospital Children | $32K |
| 18 | 1134152549 | $28K |
| 19 | Newark Beth Israel Medical Center Inc Newark, NJ · General Acute Care Hospital | $28K |
| 20 | 1710977012 | $28K |
Showing top 20 of 148 providers billing this code