#3581 of 11K

A5054

HCPCS Procedure Code

HCPCS code A5054 is the #3,581 most-billed Medicaid procedure code, with $1.5M in payments across 33K claims from 2018–2024. The national median cost per claim is $35.16. Costs vary widely — the 90th percentile is $73.54 per claim, 2.1× the median.

Total Paid

$1.5M

0.00% of all spending

Total Claims

33K

Providers

Avg Cost/Claim

$45

National Cost Distribution

How much do providers bill per claim for A5054? Based on 27 providers billing this code nationally.

Median

$35.16

Average

$40.40

Std Dev

$23.17

Max

$80.48

Percentile Distribution (Cost per Claim)

p10

$9.15

p25

$26.08

Median

$35.16

p75

$54.97

p90

$73.54

p95

$77.35

p99

$80.03

50% of providers bill between $26.08 and $54.97 per claim for this code.

90% bill between $9.15 and $73.54.

Top 1% bill above $80.03.

About This Procedure

HCPCS code A5054 was billed by 27 providers across 33K claims, totaling $1.5M in Medicaid payments from 2018–2024. This code was used for 29K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$35.16

Providers Billing

National Spending

$1.5M

Avg/Median Ratio

1.15×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for A5054

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Rgh Enterprises, Llc Twinsburg, OH · Prosthetic/Orthotic Supplier	$296K	$51.03	1.5× median	Above Median
2	Byram Healthcare Centers, Inc. Downers Grove, IL · Durable Medical Equipment & Medical Supplies	$254K	$41.60	1.2× median	Above Median
3	180 Medical Inc Oklahoma City, OK · Durable Medical Equipment & Medical Supplies, Customized Equipment	$221K	$57.16	1.6× median	Above 75th
4	1609024397	$178K	$67.21	1.9× median	Above 75th
5	1881698439	$77K	$32.86	0.9× median	Below Median
6	1649244138	$71K	$24.79	0.7× median	Below Median
7	Byram Healthcare Centers, Inc. Torrance, CA · Durable Medical Equipment & Medical Supplies	$66K	$80.48	2.3× median	Top 1%
8	1710932173	$61K	$78.73	2.2× median	Top 10%
9	Shield California Health Care Center Inc Valencia, CA · Durable Medical Equipment & Medical Supplies	$44K	$73.15	2.1× median	Above 75th
10	Home Care Delivered, Inc. Richmond, VA · Durable Medical Equipment & Medical Supplies	$43K	$28.98	0.8× median	Below Median
11	1568083087	$36K	$35.16	1.0× median	Below Median
12	Medline Industries, Lp Grayslake, IL · Durable Medical Equipment & Medical Supplies	$30K	$27.37	0.8× median	Below Median
13	Byram Healthcare Centers, Inc. Portland, OR · Durable Medical Equipment & Medical Supplies	$20K	$74.13	2.1× median	Top 10%
14	1609104736	$16K	$27.86	0.8× median	Below Median
15	1023063641	$14K	$63.22	1.8× median	Above 75th
16	1013124213	$11K	$10.72	0.3× median	Below Median
17	1992891238	$10K	$31.26	0.9× median	Below Median
18	Degc Enterprises (U.s.), Inc. Clearwater, FL · Durable Medical Equipment & Medical Supplies	$5K	$22.26	0.6× median	Below Median
19	1346295953	$4K	$51.99	1.5× median	Above Median
20	1891808853	$4K	$6.80	0.2× median	Below Median

Showing top 20 of 27 providers billing this code

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