#3294 of 11K

85097

HCPCS Procedure Code

HCPCS code 85097 is the #3,294 most-billed Medicaid procedure code, with $2.0M in payments across 47K claims from 2018–2024. The national median cost per claim is $30.47. Costs vary widely — the 90th percentile is $62.05 per claim, 2.0× the median.

Total Paid

$2.0M

0.00% of all spending

Total Claims

47K

Providers

176

Avg Cost/Claim

$43

National Cost Distribution

How much do providers bill per claim for 85097? Based on 174 providers billing this code nationally.

Median

$30.47

Average

$39.05

Std Dev

$56.09

Max

$704.46

Percentile Distribution (Cost per Claim)

p10

$13.19

p25

$21.14

Median

$30.47

p75

$39.16

p90

$62.05

p95

$92.64

p99

$133.42

50% of providers bill between $21.14 and $39.16 per claim for this code.

90% bill between $13.19 and $62.05.

Top 1% bill above $133.42.

About This Procedure

HCPCS code 85097 was billed by 176 providers across 47K claims, totaling $2.0M in Medicaid payments from 2018–2024. This code was used for 41K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$30.47

Providers Billing

174

National Spending

$2.0M

Avg/Median Ratio

1.28×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 85097

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1821143777	$383K	$704.46	23.1× median	Top 1%
2	Memorial Hospital For Cancer And Allied Diseases New York, NY · Pharmacy	$191K	$99.21	3.3× median	Top 10%
3	1871886366	$100K	$31.32	1.0× median	Above Median
4	1316241102	$83K	$41.67	1.4× median	Above 75th
5	1740460583	$79K	$46.51	1.5× median	Above 75th
6	Hartford Hospital Hartford, CT · General Acute Care Hospital	$78K	$157.52	5.2× median	Top 1%
7	Bioreference Health Llc Elmwood Park, NJ · Clinical Medical Laboratory	$68K	$20.17	0.7× median	Below Median
8	1508890468	$46K	$31.99	1.1× median	Above Median
9	1437292927	$46K	$40.57	1.3× median	Above 75th
10	Phoenix Children's Hospital Phoenix, AZ · Pediatrics	$42K	$46.38	1.5× median	Above 75th
11	1740240753	$38K	$26.99	0.9× median	Below Median
12	1467433292	$37K	$26.03	0.9× median	Below Median
13	1174503999	$37K	$36.11	1.2× median	Above Median
14	1003319500	$36K	$49.24	1.6× median	Above 75th
15	1306335088	$35K	$32.04	1.1× median	Above Median
16	1083662498	$29K	$38.00	1.2× median	Above Median
17	Froedtert Memorial Lutheran Hospital, Inc. Milwaukee, WI · Clinic/Center, Radiology	$29K	$30.51	1.0× median	Above Median
18	1871615708	$29K	$19.67	0.6× median	Below Median
19	1487600334	$28K	$27.65	0.9× median	Below Median
20	William Beaumont Hospital Royal Oak, MI · Internal Medicine, Cardiovascular Disease	$28K	$31.09	1.0× median	Above Median

Showing top 20 of 176 providers billing this code

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