86945
HCPCS Procedure Code
HCPCS code 86945 is the #3,999 most-billed Medicaid procedure code, with $941K in payments across 73K claims from 2018–2024. The national median cost per claim is $11.40. Costs vary widely — the 90th percentile is $51.88 per claim, 4.6× the median.
Total Paid
$941K
0.00% of all spending
Total Claims
73K
Providers
40
Avg Cost/Claim
$13
National Cost Distribution
How much do providers bill per claim for 86945? Based on 35 providers billing this code nationally.
Median
$11.40
Average
$20.89
Std Dev
$22.07
Max
$98.84
Percentile Distribution (Cost per Claim)
50% of providers bill between $4.40 and $29.44 per claim for this code.
90% bill between $2.32 and $51.88.
Top 1% bill above $84.69.
About This Procedure
HCPCS code 86945 was billed by 40 providers across 73K claims, totaling $941K in Medicaid payments from 2018–2024. This code was used for 39K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$11.40
Providers Billing
35
National Spending
$941K
Avg/Median Ratio
1.83×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for 86945
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1316241102 | $181K |
| 2 | Childrens Hospital Of Los Angeles Los Angeles, CA · Case Manager/Care Coordinator | $160K |
| 3 | Norton Hospitals Inc Louisville, KY · General Acute Care Hospital | $70K |
| 4 | Unm Hospital Albuquerque, NM · General Acute Care Hospital | $58K |
| 5 | 1922008150 | $53K |
| 6 | Seventh-day Adventists Loma Linda University Medical Center Loma Linda, CA · General Acute Care Hospital | $50K |
| 7 | University Of Kentucky Lexington, KY · General Acute Care Hospital | $48K |
| 8 | Children's Hospital Of Wisconsin, Inc. Milwaukee, WI · Dentist, Pediatric Dentistry | $48K |
| 9 | 1437230034 | $44K |
| 10 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $43K |
| 11 | Norton Hospitals, Inc Louisville, KY · General Acute Care Hospital | $35K |
| 12 | Children's Hospital Washington, DC · General Acute Care Hospital Children | $28K |
| 13 | 1205935012 | $19K |
| 14 | The General Hospital Corporation Boston, MA · General Acute Care Hospital | $15K |
| 15 | 1457354656 | $15K |
| 16 | Childrens Hospital Of Philadelphia Philadelphia, PA · General Acute Care Hospital Children | $15K |
| 17 | Arkansas Childrens Hospital Little Rock, AR · Clinic/Center, Critical Access Hospital | $11K |
| 18 | Loma Linda University Children's Hospital Loma Linda, CA · General Acute Care Hospital Children | $7K |
| 19 | 1790711927 | $7K |
| 20 | Regents Of The University Of California San Diego, CA · General Acute Care Hospital | $6K |
Showing top 20 of 40 providers billing this code