#6029 of 11K

95974

HCPCS Procedure Code

HCPCS code 95974 is the #6,029 most-billed Medicaid procedure code, with $104K in payments across 2,058 claims from 2018–2024. The national median cost per claim is $55.14. Costs vary widely — the 90th percentile is $180.59 per claim, 3.3× the median.

Total Paid

$104K

0.00% of all spending

Total Claims

2,058

Providers

Avg Cost/Claim

$50

National Cost Distribution

How much do providers bill per claim for 95974? Based on 24 providers billing this code nationally.

Median

$55.14

Average

$80.97

Std Dev

$68.26

Max

$257.90

Percentile Distribution (Cost per Claim)

p10

$24.15

p25

$41.12

Median

$55.14

p75

$98.19

p90

$180.59

p95

$224.00

p99

$251.71

50% of providers bill between $41.12 and $98.19 per claim for this code.

90% bill between $24.15 and $180.59.

Top 1% bill above $251.71.

About This Procedure

HCPCS code 95974 was billed by 24 providers across 2,058 claims, totaling $104K in Medicaid payments from 2018–2024. This code was used for 1,476 unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$55.14

Providers Billing

National Spending

$104K

Avg/Median Ratio

1.47×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 95974

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1043402522	$14K	$43.57	0.8× median	Below Median
2	Virginia Commonwealth University Health System Authority Richmond, VA · General Acute Care Hospital	$12K	$231.00	4.2× median	Top 10%
3	1588614168	$10K	$17.76	0.3× median	Below Median
4	1710929088	$10K	$59.54	1.1× median	Above Median
5	Childrens Hospital Of Los Angeles Los Angeles, CA · Case Manager/Care Coordinator	$7K	$257.90	4.7× median	Top 1%
6	1023064482	$5K	$88.41	1.6× median	Above Median
7	1568400356	$5K	$31.24	0.6× median	Below Median
8	1477738128	$5K	$171.85	3.1× median	Above 75th
9	1356765556	$5K	$68.42	1.2× median	Above Median
10	1609915784	$4K	$49.37	0.9× median	Below Median
11	1114982774	$4K	$42.31	0.8× median	Below Median
12	1063453991	$3K	$47.13	0.9× median	Below Median
13	1730183286	$3K	$77.30	1.4× median	Above Median
14	1033164462	$3K	$131.13	2.4× median	Above 75th
15	Broadlawns Medical Center Des Moines, IA · General Acute Care Hospital	$2K	$71.94	1.3× median	Above Median
16	University Of Wisconsin Hospitals And Clinics Authority Madison, WI · General Acute Care Hospital	$2K	$184.34	3.3× median	Top 10%
17	1578545273	$2K	$24.47	0.4× median	Below Median
18	1710959457	$2K	$127.52	2.3× median	Above 75th
19	1720009681	$2K	$50.74	0.9× median	Below Median
20	1699179929	$912	$24.01	0.4× median	Below Median

Showing top 20 of 24 providers billing this code

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