#5255 of 11K

A4212

HCPCS Procedure Code

HCPCS code A4212 is the #5,255 most-billed Medicaid procedure code, with $249K in payments across 35K claims from 2018–2024. The national median cost per claim is $10.64. Costs vary widely — the 90th percentile is $38.65 per claim, 3.6× the median.

Total Paid

$249K

0.00% of all spending

Total Claims

35K

Providers

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for A4212? Based on 25 providers billing this code nationally.

Median

$10.64

Average

$14.82

Std Dev

$14.81

Max

$47.00

Percentile Distribution (Cost per Claim)

p10

$0.67

p25

$2.39

Median

$10.64

p75

$23.96

p90

$38.65

p95

$42.95

p99

$46.06

50% of providers bill between $2.39 and $23.96 per claim for this code.

90% bill between $0.67 and $38.65.

Top 1% bill above $46.06.

About This Procedure

HCPCS code A4212 was billed by 35 providers across 35K claims, totaling $249K in Medicaid payments from 2018–2024. This code was used for 18K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$10.64

Providers Billing

National Spending

$249K

Avg/Median Ratio

1.39×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for A4212

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1801866173	$65K	$42.41	4.0× median	Top 10%
2	1417904574	$52K	$23.96	2.3× median	Above Median
3	1538405659	$39K	$43.08	4.0× median	Top 10%
4	1699853713	$37K	$22.65	2.1× median	Above Median
5	1013942788	$18K	$8.91	0.8× median	Below Median
6	1275612673	$15K	$30.28	2.8× median	Above 75th
7	1124098421	$7K	$1.05	0.1× median	Below Median
8	1477559433	$4K	$12.81	1.2× median	Above Median
9	1215966205	$3K	$28.47	2.7× median	Above 75th
10	Riverside University Health Systems - Medical Center Moreno Valley, CA · General Acute Care Hospital	$2K	$47.00	4.4× median	Top 1%
11	1831241033	$1K	$10.64	1.0× median	Below Median
12	Childrens Hospital Of Philadelphia Philadelphia, PA · General Acute Care Hospital Children	$1K	$13.19	1.2× median	Above Median
13	1255644357	$987	$11.09	1.0× median	Above Median
14	1790730612	$894	$0.59	0.1× median	Below Median
15	1255330403	$809	$5.62	0.5× median	Below Median
16	Albert Einstein Medical Center Phila, PA · General Acute Care Hospital	$766	$7.44	0.7× median	Below Median
17	1881698215	$612	$3.52	0.3× median	Below Median
18	1407864374	$429	$33.03	3.1× median	Above 75th
19	1962462382	$274	$0.58	0.1× median	Below Median
20	1366435976	$255	$14.16	1.3× median	Above Median

Showing top 20 of 35 providers billing this code

Related Procedures

A4222$96.4M A4217Sterile water or saline for nebulizer, per unit$25.9M A4221Supplies for maintenance of drug infusion catheter$24.1M A4216$16.6M A4215Sterile needle, each$13.6M

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