85397
HCPCS Procedure Code
HCPCS code 85397 is the #4,628 most-billed Medicaid procedure code, with $479K in payments across 22K claims from 2018–2024. The national median cost per claim is $21.78. Costs vary widely — the 90th percentile is $58.33 per claim, 2.7× the median.
Total Paid
$479K
0.00% of all spending
Total Claims
22K
Providers
48
Avg Cost/Claim
$22
National Cost Distribution
How much do providers bill per claim for 85397? Based on 44 providers billing this code nationally.
Median
$21.78
Average
$33.57
Std Dev
$48.18
Max
$302.48
Percentile Distribution (Cost per Claim)
50% of providers bill between $13.59 and $28.34 per claim for this code.
90% bill between $9.60 and $58.33.
Top 1% bill above $224.25.
About This Procedure
HCPCS code 85397 was billed by 48 providers across 22K claims, totaling $479K in Medicaid payments from 2018–2024. This code was used for 20K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$21.78
Providers Billing
44
National Spending
$479K
Avg/Median Ratio
1.54×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for 85397
| # | Provider | Total Paid |
|---|---|---|
| 1 | Children's Hospital Of Wisconsin, Inc. Milwaukee, WI · Dentist, Pediatric Dentistry | $130K |
| 2 | 1700949336 | $61K |
| 3 | Mayo Collaborative Services, Inc Rochester, MN · Clinical Medical Laboratory | $45K |
| 4 | Scottish Rite Children's Medical Center Atlanta, GA · Pediatrics Pediatric Hematology-Oncology | $42K |
| 5 | 1689744450 | $23K |
| 6 | Egleston Children's Hospital At Emory University Inc. Atlanta, GA · Pediatrics Pediatric Emergency Medicine | $23K |
| 7 | Permanente Medical Group, Inc. Richmond, CA · Clinical Medical Laboratory | $20K |
| 8 | Laboratory Corporation Of America Holdings Burlington, NC · Clinical Medical Laboratory | $18K |
| 9 | Children's Health System Of Texas Dallas, TX · General Acute Care Hospital Children | $17K |
| 10 | Children's Hospital Medical Center Of Akron Akron, OH · General Acute Care Hospital Children | $16K |
| 11 | State Of Mississippi - University Of Mississippi Medical Center Jackson, MS · General Acute Care Hospital | $10K |
| 12 | North Shore Medical Center, Inc. Salem, MA · General Acute Care Hospital | $9K |
| 13 | The Toledo Hospital Toledo, OH · Pediatrics | $8K |
| 14 | Spectrum Health Hospitals Grand Rapids, MI · General Acute Care Hospital | $7K |
| 15 | Norton Hospitals Inc Louisville, KY · General Acute Care Hospital | $5K |
| 16 | Quest Diagnostics Llc Il Wood Dale, IL · Clinical Medical Laboratory | $5K |
| 17 | Regents Of The University Of Michigan Ann Arbor, MI · Clinic/Center, End-Stage Renal Disease (ESRD) Treatment | $5K |
| 18 | Texas Children's Hospital Houston, TX · General Acute Care Hospital Children | $4K |
| 19 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $4K |
| 20 | 1235186800 | $4K |
Showing top 20 of 48 providers billing this code