#1718 of 11K

90474

HCPCS Procedure Code

HCPCS code 90474 is the #1,718 most-billed Medicaid procedure code, with $15.5M in payments across 2.0M claims from 2018–2024. The national median cost per claim is $8.42. Costs vary widely — the 90th percentile is $18.34 per claim, 2.2× the median.

Total Paid

$15.5M

0.00% of all spending

Total Claims

2.0M

Providers

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for 90474? Based on 2K providers billing this code nationally.

Median

$8.42

Average

$9.01

Std Dev

$6.83

Max

$90.48

Percentile Distribution (Cost per Claim)

p10

$0.76

p25

$4.00

Median

$8.42

p75

$12.26

p90

$18.34

p95

$19.67

p99

$21.66

50% of providers bill between $4.00 and $12.26 per claim for this code.

90% bill between $0.76 and $18.34.

Top 1% bill above $21.66.

About This Procedure

HCPCS code 90474 was billed by 2K providers across 2.0M claims, totaling $15.5M in Medicaid payments from 2018–2024. This code was used for 1.8M unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$8.42

Providers Billing

National Spending

$15.5M

Avg/Median Ratio

1.07×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 90474

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Community Physicians Of Indiana Inc Indianapolis, IN · Internal Medicine	$316K	$11.93	1.4× median	Above Median
2	Cook Children's Physician Network Fort Worth, TX · Medical Genetics, Clinical Genetics (M.D.)	$294K	$10.27	1.2× median	Above Median
3	Our Lady Of The Lake Physician Group Llc Baton Rouge, LA · Allergy & Immunology	$268K	$7.77	0.9× median	Below Median
4	Bexar County Hospital District San Antonio, TX · Clinical Medical Laboratory	$234K	$14.58	1.7× median	Above 75th
5	1265499628	$226K	$8.04	1.0× median	Below Median
6	1073693347	$222K	$19.67	2.3× median	Top 10%
7	1326110909	$213K	$10.82	1.3× median	Above Median
8	1932130952	$190K	$10.22	1.2× median	Above Median
9	1134163942	$186K	$17.80	2.1× median	Above 75th
10	1063846699	$184K	$18.02	2.1× median	Above 75th
11	1336564863	$175K	$19.07	2.3× median	Top 10%
12	Wake Forest University Health Sciences Winston Salem, NC · Clinic/Center, Multi-Specialty	$171K	$18.88	2.2× median	Top 10%
13	1134118292	$163K	$19.34	2.3× median	Top 10%
14	1427018894	$154K	$19.48	2.3× median	Top 10%
15	1598729014	$145K	$19.11	2.3× median	Top 10%
16	1700228418	$121K	$17.87	2.1× median	Above 75th
17	1477648731	$118K	$19.02	2.3× median	Top 10%
18	Unm Hospital Albuquerque, NM · General Acute Care Hospital	$110K	$21.23	2.5× median	Top 10%
19	1073620498	$109K	$8.56	1.0× median	Above Median
20	1235439613	$107K	$18.51	2.2× median	Top 10%

Showing top 20 of 2K providers billing this code

Related Procedures

90471Immunization administration, 1 vaccine, percutaneous/ID/SC/IM$551.7M 90472Immunization administration, each additional vaccine$269.0M 90480$26.0M 90473Immunization admin, intranasal, first$5.0M 90476$5K

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