86409
HCPCS Procedure Code
HCPCS code 86409 is the #4,523 most-billed Medicaid procedure code, with $533K in payments across 15K claims from 2018–2024. The national median cost per claim is $34.09. Costs vary widely — the 90th percentile is $81.41 per claim, 2.4× the median.
Total Paid
$533K
0.00% of all spending
Total Claims
15K
Providers
23
Avg Cost/Claim
$36
National Cost Distribution
How much do providers bill per claim for 86409? Based on 17 providers billing this code nationally.
Median
$34.09
Average
$39.59
Std Dev
$31.00
Max
$93.24
Percentile Distribution (Cost per Claim)
50% of providers bill between $12.01 and $72.99 per claim for this code.
90% bill between $7.99 and $81.41.
Top 1% bill above $91.77.
About This Procedure
HCPCS code 86409 was billed by 23 providers across 15K claims, totaling $533K in Medicaid payments from 2018–2024. This code was used for 14K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$34.09
Providers Billing
17
National Spending
$533K
Avg/Median Ratio
1.16×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 86409
| # | Provider | Total Paid |
|---|---|---|
| 1 | Empire City Laboratories, Inc Brooklyn, NY · Clinical Medical Laboratory | $383K |
| 2 | 1346989704 | $48K |
| 3 | 1346514619 | $31K |
| 4 | 1730708215 | $19K |
| 5 | 1144757212 | $9K |
| 6 | 1659755908 | $8K |
| 7 | Orchard Laboratories Corp West Bloomfield, MI · Clinical Medical Laboratory | $7K |
| 8 | 1255726626 | $7K |
| 9 | 1447925516 | $5K |
| 10 | 1568994879 | $4K |
| 11 | 1225191505 | $4K |
| 12 | Medarbor Llc Bristol, PA · Clinical Medical Laboratory | $3K |
| 13 | 1427521525 | $3K |
| 14 | 1386246858 | $2K |
| 15 | 1437605615 | $971 |
| 16 | 1588029771 | $318 |
| 17 | 1861095069 | $316 |
| 18 | 1730658279 | $0 |
| 19 | 1285332502 | $0 |
| 20 | 1538533799 | $0 |
Showing top 20 of 23 providers billing this code