#4490 of 11K

85380

HCPCS Procedure Code

HCPCS code 85380 is the #4,490 most-billed Medicaid procedure code, with $554K in payments across 168K claims from 2018–2024. The national median cost per claim is $3.43. Costs vary widely — the 90th percentile is $9.73 per claim, 2.8× the median.

Total Paid

$554K

0.00% of all spending

Total Claims

168K

Providers

132

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for 85380? Based on 122 providers billing this code nationally.

Median

$3.43

Average

$4.86

Std Dev

$5.20

Max

$26.74

Percentile Distribution (Cost per Claim)

p10

$0.41

p25

$0.85

Median

$3.43

p75

$6.80

p90

$9.73

p95

$15.74

p99

$22.55

50% of providers bill between $0.85 and $6.80 per claim for this code.

90% bill between $0.41 and $9.73.

Top 1% bill above $22.55.

About This Procedure

HCPCS code 85380 was billed by 132 providers across 168K claims, totaling $554K in Medicaid payments from 2018–2024. This code was used for 148K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$3.43

Providers Billing

122

National Spending

$554K

Avg/Median Ratio

1.42×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 85380

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1629138250	$29K	$6.17	1.8× median	Above Median
2	Long Island Jewish Medical Center New Hyde Park, NY · General Acute Care Hospital	$29K	$15.75	4.6× median	Top 10%
3	University Of Rochester Rochester, NY · General Acute Care Hospital	$28K	$13.17	3.8× median	Top 10%
4	Public Hospital District 1 Of King County Renton, WA · General Acute Care Hospital	$28K	$4.86	1.4× median	Above Median
5	1902832306	$25K	$7.54	2.2× median	Above 75th
6	1770693939	$19K	$3.48	1.0× median	Above Median
7	1518993880	$18K	$7.84	2.3× median	Above 75th
8	1780196345	$16K	$26.74	7.8× median	Top 1%
9	1548260839	$16K	$6.10	1.8× median	Above Median
10	1821196486	$16K	$7.99	2.3× median	Above 75th
11	Tufts Medical Center, Inc. Boston, MA · General Acute Care Hospital	$14K	$6.78	2.0× median	Above Median
12	1780633289	$14K	$3.94	1.1× median	Above Median
13	1518952761	$13K	$4.21	1.2× median	Above Median
14	1407877137	$12K	$21.04	6.1× median	Top 10%
15	1992776041	$11K	$7.16	2.1× median	Above 75th
16	1679677983	$10K	$6.74	2.0× median	Above Median
17	Montefiore Medical Center Bronx, NY · General Acute Care Hospital	$10K	$15.64	4.6× median	Top 10%
18	Jersey City Medical Center Jersey City, NJ · General Acute Care Hospital	$10K	$8.79	2.6× median	Above 75th
19	1194926279	$10K	$3.12	0.9× median	Below Median
20	Atlanticare Regional Medical Center Pomona, NJ · General Acute Care Hospital	$9K	$1.39	0.4× median	Below Median

Showing top 20 of 132 providers billing this code

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