86904
HCPCS Procedure Code
HCPCS code 86904 is the #7,831 most-billed Medicaid procedure code, with $9K in payments across 2K claims from 2018–2024. The national median cost per claim is $3.85. Costs vary widely — the 90th percentile is $10.53 per claim, 2.7× the median.
Total Paid
$9K
0.00% of all spending
Total Claims
2K
Providers
8
Avg Cost/Claim
$5
National Cost Distribution
How much do providers bill per claim for 86904? Based on 6 providers billing this code nationally.
Median
$3.85
Average
$5.10
Std Dev
$5.00
Max
$13.44
Percentile Distribution (Cost per Claim)
50% of providers bill between $1.27 and $7.26 per claim for this code.
90% bill between $0.92 and $10.53.
Top 1% bill above $13.15.
About This Procedure
HCPCS code 86904 was billed by 8 providers across 2K claims, totaling $9K in Medicaid payments from 2018–2024. This code was used for 2K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$3.85
Providers Billing
6
National Spending
$9K
Avg/Median Ratio
1.32×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 86904
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1568469997 | $5K |
| 2 | 1902010903 | $4K |
| 3 | 1861494072 | $387 |
| 4 | 1740265347 | $188 |
| 5 | 1972503647 | $124 |
| 6 | 1235265851 | $35 |
| 7 | Yale New Haven Hospital New Haven, CT · General Acute Care Hospital | $0 |
| 8 | 1134183791 | $0 |
Showing top 8 of 8 providers billing this code