#1635 of 11K

93243

HCPCS Procedure Code

HCPCS code 93243 is the #1,635 most-billed Medicaid procedure code, with $17.4M in payments across 207K claims from 2018–2024. The national median cost per claim is $43.86. Costs vary widely — the 90th percentile is $158.95 per claim, 3.6× the median.

Total Paid

$17.4M

0.00% of all spending

Total Claims

207K

Providers

Avg Cost/Claim

$84

National Cost Distribution

How much do providers bill per claim for 93243? Based on 53 providers billing this code nationally.

Median

$43.86

Average

$66.87

Std Dev

$59.41

Max

$247.96

Percentile Distribution (Cost per Claim)

p10

$15.92

p25

$22.94

Median

$43.86

p75

$106.00

p90

$158.95

p95

$181.33

p99

$231.72

50% of providers bill between $22.94 and $106.00 per claim for this code.

90% bill between $15.92 and $158.95.

Top 1% bill above $231.72.

About This Procedure

HCPCS code 93243 was billed by 55 providers across 207K claims, totaling $17.4M in Medicaid payments from 2018–2024. This code was used for 194K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$43.86

Providers Billing

National Spending

$17.4M

Avg/Median Ratio

1.52×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for 93243

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1790869402	$10.5M	$164.01	3.7× median	Top 10%
2	1710130539	$4.1M	$65.34	1.5× median	Above Median
3	1063414258	$928K	$23.36	0.5× median	Below Median
4	1477214906	$301K	$26.03	0.6× median	Below Median
5	1588664940	$293K	$123.20	2.8× median	Above 75th
6	Nationwide Children's Hospital Columbus, OH · General Acute Care Hospital	$193K	$162.10	3.7× median	Top 10%
7	1932697729	$184K	$21.92	0.5× median	Below Median
8	1598092942	$122K	$119.40	2.7× median	Above 75th
9	1255761664	$94K	$58.06	1.3× median	Above Median
10	County Of Santa Clara San Jose, CA · Case Manager/Care Coordinator	$65K	$55.50	1.3× median	Above Median
11	1467563387	$57K	$146.37	3.3× median	Above 75th
12	1497160717	$52K	$114.22	2.6× median	Above 75th
13	Seventh-day Adventists Loma Linda University Medical Center Loma Linda, CA · General Acute Care Hospital	$49K	$111.27	2.5× median	Above 75th
14	Newark Beth Israel Medical Center Inc Newark, NJ · General Acute Care Hospital	$45K	$216.72	4.9× median	Top 10%
15	1407471550	$37K	$11.91	0.3× median	Below Median
16	1255367843	$34K	$27.03	0.6× median	Below Median
17	1912683814	$31K	$19.98	0.5× median	Below Median
18	1467440743	$28K	$45.94	1.0× median	Above Median
19	Children's Health System Of Texas Dallas, TX · General Acute Care Hospital Children	$22K	$247.96	5.7× median	Top 1%
20	University Of Kentucky Lexington, KY · General Acute Care Hospital	$16K	$97.37	2.2× median	Above Median

Showing top 20 of 55 providers billing this code

Related Procedures

93247$15.8M 93245$4.7M 93246$1.6M 93242$1.5M 93248$1.1M

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