#2314 of 11K

A5061

HCPCS Procedure Code

HCPCS code A5061 is the #2,314 most-billed Medicaid procedure code, with $6.8M in payments across 148K claims from 2018–2024. The national median cost per claim is $43.04.

Total Paid

$6.8M

0.00% of all spending

Total Claims

148K

Providers

Avg Cost/Claim

$46

National Cost Distribution

How much do providers bill per claim for A5061? Based on 95 providers billing this code nationally.

Median

$43.04

Average

$47.40

Std Dev

$31.10

Max

$175.75

Percentile Distribution (Cost per Claim)

p10

$7.49

p25

$27.23

Median

$43.04

p75

$65.63

p90

$83.98

p95

$100.60

p99

$143.01

50% of providers bill between $27.23 and $65.63 per claim for this code.

90% bill between $7.49 and $83.98.

Top 1% bill above $143.01.

About This Procedure

HCPCS code A5061 was billed by 96 providers across 148K claims, totaling $6.8M in Medicaid payments from 2018–2024. This code was used for 131K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$43.04

Providers Billing

National Spending

$6.8M

Avg/Median Ratio

1.10×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for A5061

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Shield California Health Care Center Inc Valencia, CA · Durable Medical Equipment & Medical Supplies	$944K	$101.97	2.4× median	Top 10%
2	Rgh Enterprises, Llc Twinsburg, OH · Prosthetic/Orthotic Supplier	$736K	$48.86	1.1× median	Above Median
3	Byram Healthcare Centers, Inc. Downers Grove, IL · Durable Medical Equipment & Medical Supplies	$463K	$48.73	1.1× median	Above Median
4	180 Medical Inc Oklahoma City, OK · Durable Medical Equipment & Medical Supplies, Customized Equipment	$418K	$40.18	0.9× median	Below Median
5	Byram Healthcare Centers, Inc. Torrance, CA · Durable Medical Equipment & Medical Supplies	$310K	$82.13	1.9× median	Above 75th
6	1275851800	$270K	$44.80	1.0× median	Above Median
7	H & H Drug Stores, Inc Glendale, CA · Durable Medical Equipment & Medical Supplies	$234K	$55.24	1.3× median	Above Median
8	Home Care Delivered, Inc. Richmond, VA · Durable Medical Equipment & Medical Supplies	$230K	$44.30	1.0× median	Above Median
9	1881698439	$197K	$32.60	0.8× median	Below Median
10	Medco Respiratory Instruments, Inc. Houston, TX · Durable Medical Equipment & Medical Supplies	$197K	$63.45	1.5× median	Above Median
11	1801899414	$192K	$103.93	2.4× median	Top 10%
12	1649244138	$173K	$24.87	0.6× median	Below Median
13	1710932173	$153K	$65.30	1.5× median	Above Median
14	1609104736	$139K	$33.43	0.8× median	Below Median
15	Tenderheart Health Outcomes, Inc. Austin, TX · Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition	$130K	$81.53	1.9× median	Above 75th
16	Medline Industries, Lp Grayslake, IL · Durable Medical Equipment & Medical Supplies	$116K	$36.29	0.8× median	Below Median
17	1427139641	$108K	$76.42	1.8× median	Above 75th
18	1346295953	$98K	$43.26	1.0× median	Above Median
19	1992891238	$82K	$31.89	0.7× median	Below Median
20	1013124213	$80K	$8.85	0.2× median	Below Median

Showing top 20 of 96 providers billing this code

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