#3259 of 11K

A6207

HCPCS Procedure Code

HCPCS code A6207 is the #3,259 most-billed Medicaid procedure code, with $2.1M in payments across 31K claims from 2018–2024. The national median cost per claim is $38.69. Costs vary widely — the 90th percentile is $109.12 per claim, 2.8× the median.

Total Paid

$2.1M

0.00% of all spending

Total Claims

31K

Providers

Avg Cost/Claim

$67

National Cost Distribution

How much do providers bill per claim for A6207? Based on 36 providers billing this code nationally.

Median

$38.69

Average

$53.82

Std Dev

$57.69

Max

$253.73

Percentile Distribution (Cost per Claim)

p10

$1.02

p25

$11.13

Median

$38.69

p75

$71.19

p90

$109.12

p95

$186.66

p99

$231.99

50% of providers bill between $11.13 and $71.19 per claim for this code.

90% bill between $1.02 and $109.12.

Top 1% bill above $231.99.

About This Procedure

HCPCS code A6207 was billed by 39 providers across 31K claims, totaling $2.1M in Medicaid payments from 2018–2024. This code was used for 24K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$38.69

Providers Billing

National Spending

$2.1M

Avg/Median Ratio

1.39×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for A6207

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1649244138	$1.1M	$253.73	6.6× median	Top 1%
2	1548367063	$200K	$29.37	0.8× median	Below Median
3	Home Care Delivered, Inc. Richmond, VA · Durable Medical Equipment & Medical Supplies	$149K	$106.04	2.7× median	Above 75th
4	Byram Healthcare Centers, Inc. Downers Grove, IL · Durable Medical Equipment & Medical Supplies	$104K	$33.42	0.9× median	Below Median
5	Byram Healthcare Centers, Inc. Torrance, CA · Durable Medical Equipment & Medical Supplies	$101K	$112.21	2.9× median	Top 10%
6	1710932173	$86K	$49.87	1.3× median	Above Median
7	Continuum, Llc Philadelphia, PA · Durable Medical Equipment & Medical Supplies	$69K	$63.27	1.6× median	Above Median
8	1730174764	$53K	$72.43	1.9× median	Above 75th
9	1679653356	$48K	$93.42	2.4× median	Above 75th
10	1073692794	$42K	$191.60	5.0× median	Top 10%
11	Medline Industries, Lp Grayslake, IL · Durable Medical Equipment & Medical Supplies	$40K	$34.44	0.9× median	Below Median
12	1295800068	$33K	$185.01	4.8× median	Top 10%
13	Providence Health & Services Washington Anchorage, AK · General Acute Care Hospital	$23K	$5.74	0.1× median	Below Median
14	1427139641	$22K	$70.77	1.8× median	Above Median
15	1023438538	$21K	$37.39	1.0× median	Below Median
16	Rgh Enterprises, Llc Twinsburg, OH · Prosthetic/Orthotic Supplier	$20K	$64.72	1.7× median	Above Median
17	1750736500	$12K	$39.98	1.0× median	Above Median
18	1023063641	$9K	$32.50	0.8× median	Below Median
19	1912952375	$8K	$75.21	1.9× median	Above 75th
20	1346295953	$4K	$26.58	0.7× median	Below Median

Showing top 20 of 39 providers billing this code

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A6197$78.7M A6212$60.0M A6210$34.5M A6209$23.9M A6211$14.6M

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