86403
HCPCS Procedure Code
HCPCS code 86403 is the #3,624 most-billed Medicaid procedure code, with $1.4M in payments across 224K claims from 2018–2024. The national median cost per claim is $6.03. Costs vary widely — the 90th percentile is $13.51 per claim, 2.2× the median.
Total Paid
$1.4M
0.00% of all spending
Total Claims
224K
Providers
335
Avg Cost/Claim
$6
National Cost Distribution
How much do providers bill per claim for 86403? Based on 306 providers billing this code nationally.
Median
$6.03
Average
$7.11
Std Dev
$6.98
Max
$63.46
Percentile Distribution (Cost per Claim)
50% of providers bill between $2.33 and $9.45 per claim for this code.
90% bill between $0.90 and $13.51.
Top 1% bill above $29.27.
About This Procedure
HCPCS code 86403 was billed by 335 providers across 224K claims, totaling $1.4M in Medicaid payments from 2018–2024. This code was used for 199K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$6.03
Providers Billing
306
National Spending
$1.4M
Avg/Median Ratio
1.18×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 86403
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1700874062 | $73K |
| 2 | 1144211020 | $56K |
| 3 | 1174579155 | $52K |
| 4 | 1821186313 | $46K |
| 5 | 1023000569 | $44K |
| 6 | 1679518724 | $43K |
| 7 | 1427055821 | $41K |
| 8 | 1194832485 | $37K |
| 9 | 1245420660 | $37K |
| 10 | Virtua - West Jersey Health System Inc. Voorhees, NJ · General Acute Care Hospital | $33K |
| 11 | 1013251594 | $32K |
| 12 | 1184771636 | $31K |
| 13 | 1114998911 | $30K |
| 14 | 1780667923 | $25K |
| 15 | 1306928072 | $24K |
| 16 | 1699726695 | $23K |
| 17 | 1740265347 | $23K |
| 18 | 1700872470 | $21K |
| 19 | 1962837377 | $20K |
| 20 | 1689625568 | $20K |
Showing top 20 of 335 providers billing this code