86920
HCPCS Procedure Code
HCPCS code 86920 is the #2,207 most-billed Medicaid procedure code, with $7.9M in payments across 299K claims from 2018–2024. The national median cost per claim is $9.61. Costs vary widely — the 90th percentile is $75.43 per claim, 7.8× the median.
Total Paid
$7.9M
0.00% of all spending
Total Claims
299K
Providers
465
Avg Cost/Claim
$26
National Cost Distribution
How much do providers bill per claim for 86920? Based on 433 providers billing this code nationally.
Median
$9.61
Average
$27.98
Std Dev
$48.67
Max
$407.88
Percentile Distribution (Cost per Claim)
50% of providers bill between $4.18 and $29.74 per claim for this code.
90% bill between $1.87 and $75.43.
Top 1% bill above $229.24.
About This Procedure
HCPCS code 86920 was billed by 465 providers across 299K claims, totaling $7.9M in Medicaid payments from 2018–2024. This code was used for 202K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$9.61
Providers Billing
433
National Spending
$7.9M
Avg/Median Ratio
2.91×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for 86920
| # | Provider | Total Paid |
|---|---|---|
| 1 | State Of Mississippi - University Of Mississippi Medical Center Jackson, MS · General Acute Care Hospital | $982K |
| 2 | Scottish Rite Children's Medical Center Atlanta, GA · Pediatrics Pediatric Hematology-Oncology | $804K |
| 3 | Egleston Children's Hospital At Emory University Inc. Atlanta, GA · Pediatrics Pediatric Emergency Medicine | $643K |
| 4 | 1689744450 | $281K |
| 5 | Norton Hospitals Inc Louisville, KY · General Acute Care Hospital | $268K |
| 6 | Phoenix Children's Hospital Phoenix, AZ · General Acute Care Hospital Children | $267K |
| 7 | Children's Hospital & Research Center At Oakland Oakland, CA · General Acute Care Hospital | $256K |
| 8 | Integrated Regional Laboratories Pathology Services Llc Atlantis, FL · Pathology Anatomic Pathology & Clinical Pathology | $171K |
| 9 | Children's Hospital Of Wisconsin, Inc. Milwaukee, WI · Dentist, Pediatric Dentistry | $164K |
| 10 | Banner - University Medical Center Phoenix Phoenix, AZ · Clinic/Center, Sleep Disorder Diagnostic | $141K |
| 11 | Carolinas Medical Center Charlotte, NC · General Acute Care Hospital | $128K |
| 12 | Norton Hospitals, Inc Louisville, KY · General Acute Care Hospital | $120K |
| 13 | Keck Medical Center Of Usc Los Angeles, CA · General Acute Care Hospital | $114K |
| 14 | 1952546616 | $113K |
| 15 | 1033112230 | $102K |
| 16 | Nationwide Children's Hospital Columbus, OH · General Acute Care Hospital | $101K |
| 17 | 1225041809 | $100K |
| 18 | Providence Health & Services Washington Anchorage, AK · General Acute Care Hospital | $95K |
| 19 | Charleston Area Medical Center Inc Charleston, WV · General Acute Care Hospital | $92K |
| 20 | Riverside University Health Systems - Medical Center Moreno Valley, CA · General Acute Care Hospital | $88K |
Showing top 20 of 465 providers billing this code