85396
HCPCS Procedure Code
HCPCS code 85396 is the #5,479 most-billed Medicaid procedure code, with $190K in payments across 15K claims from 2018–2024. The national median cost per claim is $6.78. Costs vary widely — the 90th percentile is $23.15 per claim, 3.4× the median.
Total Paid
$190K
0.00% of all spending
Total Claims
15K
Providers
27
Avg Cost/Claim
$12
National Cost Distribution
How much do providers bill per claim for 85396? Based on 23 providers billing this code nationally.
Median
$6.78
Average
$12.97
Std Dev
$21.61
Max
$79.89
Percentile Distribution (Cost per Claim)
50% of providers bill between $2.63 and $9.79 per claim for this code.
90% bill between $1.12 and $23.15.
Top 1% bill above $79.52.
About This Procedure
HCPCS code 85396 was billed by 27 providers across 15K claims, totaling $190K in Medicaid payments from 2018–2024. This code was used for 9,342 unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$6.78
Providers Billing
23
National Spending
$190K
Avg/Median Ratio
1.91×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for 85396
| # | Provider | Total Paid |
|---|---|---|
| 1 | The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital | $58K |
| 2 | 1326447939 | $55K |
| 3 | 1235126921 | $25K |
| 4 | 1487600334 | $14K |
| 5 | Medical University Hospital Authority Charleston, SC · General Acute Care Hospital | $11K |
| 6 | 1689695934 | $10K |
| 7 | 1902885890 | $7K |
| 8 | 1588654016 | $2K |
| 9 | 1477549756 | $2K |
| 10 | 1144277633 | $1K |
| 11 | 1114547114 | $1K |
| 12 | Spartanburg Medical Center Spartanburg, SC · Ambulance | $873 |
| 13 | 1922008150 | $647 |
| 14 | 1316984388 | $369 |
| 15 | 1972582062 | $270 |
| 16 | 1811121726 | $163 |
| 17 | Integrated Regional Laboratories Pathology Services Llc Atlantis, FL · Pathology Anatomic Pathology & Clinical Pathology | $140 |
| 18 | 1316936990 | $113 |
| 19 | 1285667493 | $84 |
| 20 | 1073587937 | $62 |
Showing top 20 of 27 providers billing this code