#1881 of 11K

A5513

Diabetic therapeutic shoe, each, custom molded

Diabetic therapeutic shoe, each, custom molded is the #1,881 most-billed Medicaid procedure code, with $12.3M in payments across 254K claims from 2018–2024. The national median cost per claim is $40.80. Costs vary widely — the 90th percentile is $99.40 per claim, 2.4× the median.

Total Paid

$12.3M

0.00% of all spending

Total Claims

254K

Providers

416

Avg Cost/Claim

$48

National Cost Distribution

How much do providers bill per claim for A5513? Based on 399 providers billing this code nationally.

Median

$40.80

Average

$51.82

Std Dev

$44.52

Max

$388.91

Percentile Distribution (Cost per Claim)

p10

$14.81

p25

$25.08

Median

$40.80

p75

$63.89

p90

$99.40

p95

$133.04

p99

$267.66

50% of providers bill between $25.08 and $63.89 per claim for this code.

90% bill between $14.81 and $99.40.

Top 1% bill above $267.66.

About This Procedure

HCPCS code A5513 (Diabetic therapeutic shoe, each, custom molded) was billed by 416 providers across 254K claims, totaling $12.3M in Medicaid payments from 2018–2024. This code was used for 158K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$40.80

Providers Billing

399

National Spending

$12.3M

Avg/Median Ratio

1.27×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for A5513

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1558316851	$1.5M	$59.12	1.4× median	Above Median
2	1164586103	$528K	$40.80	1.0× median	Below Median
3	1700802147	$453K	$105.88	2.6× median	Top 10%
4	Integra Partners Llc Troy, MI · Orthotic Fitter	$365K	$54.94	1.3× median	Above Median
5	1770947897	$328K	$50.05	1.2× median	Above Median
6	1962593400	$311K	$47.96	1.2× median	Above Median
7	1104800440	$278K	$34.83	0.9× median	Below Median
8	1154352037	$234K	$96.92	2.4× median	Above 75th
9	1982615712	$219K	$50.79	1.2× median	Above Median
10	1427058650	$214K	$71.17	1.7× median	Above 75th
11	1902000771	$214K	$119.60	2.9× median	Top 10%
12	1831289826	$210K	$168.06	4.1× median	Top 10%
13	1639125081	$201K	$54.73	1.3× median	Above Median
14	1093901100	$187K	$89.30	2.2× median	Above 75th
15	1104856806	$166K	$85.19	2.1× median	Above 75th
16	1649212572	$159K	$78.13	1.9× median	Above 75th
17	1568509669	$154K	$37.57	0.9× median	Below Median
18	1629043047	$140K	$120.49	3.0× median	Top 10%
19	1215983366	$138K	$40.45	1.0× median	Below Median
20	1407039902	$134K	$26.76	0.7× median	Below Median

Showing top 20 of 416 providers billing this code

Related Procedures

A5512Diabetic shoe insert, custom molded, each$10.3M A5514$3.3M A5503$169K A5507$38K A5505$14K

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