86413
HCPCS Procedure Code
HCPCS code 86413 is the #5,667 most-billed Medicaid procedure code, with $158K in payments across 12K claims from 2018–2024. The national median cost per claim is $11.62. Costs vary widely — the 90th percentile is $53.20 per claim, 4.6× the median.
Total Paid
$158K
0.00% of all spending
Total Claims
12K
Providers
49
Avg Cost/Claim
$13
National Cost Distribution
How much do providers bill per claim for 86413? Based on 33 providers billing this code nationally.
Median
$11.62
Average
$19.92
Std Dev
$20.23
Max
$75.22
Percentile Distribution (Cost per Claim)
50% of providers bill between $4.62 and $28.45 per claim for this code.
90% bill between $1.40 and $53.20.
Top 1% bill above $70.67.
About This Procedure
HCPCS code 86413 was billed by 49 providers across 12K claims, totaling $158K in Medicaid payments from 2018–2024. This code was used for 9,539 unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$11.62
Providers Billing
33
National Spending
$158K
Avg/Median Ratio
1.71×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for 86413
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1538755376 | $34K |
| 2 | 1437605615 | $23K |
| 3 | 1538103825 | $22K |
| 4 | 1881101475 | $16K |
| 5 | Stamford Hospital Stamford, CT · Hospitalist | $11K |
| 6 | 1730708215 | $8K |
| 7 | 1659755908 | $7K |
| 8 | 1689009854 | $7K |
| 9 | 1891719902 | $4K |
| 10 | Memorial Hospital For Cancer And Allied Diseases New York, NY · Pharmacy | $4K |
| 11 | 1124018031 | $3K |
| 12 | 1386246858 | $3K |
| 13 | 1083232789 | $3K |
| 14 | 1316938301 | $2K |
| 15 | 1215055256 | $2K |
| 16 | 1386817435 | $2K |
| 17 | 1275292294 | $2K |
| 18 | 1952541963 | $1K |
| 19 | 1902980865 | $1K |
| 20 | 1922048032 | $871 |
Showing top 20 of 49 providers billing this code