A6242
HCPCS Procedure Code
HCPCS code A6242 is the #4,688 most-billed Medicaid procedure code, with $449K in payments across 21K claims from 2018–2024. The national median cost per claim is $18.83. Costs vary widely — the 90th percentile is $89.66 per claim, 4.8× the median.
Total Paid
$449K
0.00% of all spending
Total Claims
21K
Providers
20
Avg Cost/Claim
$22
National Cost Distribution
How much do providers bill per claim for A6242? Based on 20 providers billing this code nationally.
Median
$18.83
Average
$38.20
Std Dev
$38.19
Max
$138.12
Percentile Distribution (Cost per Claim)
50% of providers bill between $12.53 and $53.80 per claim for this code.
90% bill between $10.54 and $89.66.
Top 1% bill above $132.32.
About This Procedure
HCPCS code A6242 was billed by 20 providers across 21K claims, totaling $449K in Medicaid payments from 2018–2024. This code was used for 19K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$18.83
Providers Billing
20
National Spending
$449K
Avg/Median Ratio
2.03×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for A6242
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1548367063 | $189K |
| 2 | 1013124213 | $148K |
| 3 | 1962515783 | $22K |
| 4 | Byram Healthcare Centers, Inc. Downers Grove, IL · Durable Medical Equipment & Medical Supplies | $21K |
| 5 | 1376916379 | $16K |
| 6 | 1063771798 | $10K |
| 7 | 1962645374 | $10K |
| 8 | Continuum, Llc Philadelphia, PA · Durable Medical Equipment & Medical Supplies | $8K |
| 9 | 1992162911 | $8K |
| 10 | 1154479913 | $6K |
| 11 | 1710452701 | $3K |
| 12 | 1649244138 | $2K |
| 13 | Home Medical Equipment Specialists Llc Albuquerque, NM · Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies | $2K |
| 14 | 1518478478 | $1K |
| 15 | 1629269618 | $1K |
| 16 | 1730174764 | $621 |
| 17 | 1730169756 | $520 |
| 18 | 1225413743 | $451 |
| 19 | 1033436746 | $300 |
| 20 | 1295800068 | $277 |
Showing top 20 of 20 providers billing this code