#5132 of 11K

A6261

HCPCS Procedure Code

HCPCS code A6261 is the #5,132 most-billed Medicaid procedure code, with $280K in payments across 10K claims from 2018–2024. The national median cost per claim is $12.41. Costs vary widely — the 90th percentile is $65.24 per claim, 5.3× the median.

Total Paid

$280K

0.00% of all spending

Total Claims

10K

Providers

Avg Cost/Claim

$29

National Cost Distribution

How much do providers bill per claim for A6261? Based on 22 providers billing this code nationally.

Median

$12.41

Average

$21.61

Std Dev

$27.87

Max

$96.60

Percentile Distribution (Cost per Claim)

p10

$0.99

p25

$1.82

Median

$12.41

p75

$26.50

p90

$65.24

p95

$84.49

p99

$94.23

50% of providers bill between $1.82 and $26.50 per claim for this code.

90% bill between $0.99 and $65.24.

Top 1% bill above $94.23.

About This Procedure

HCPCS code A6261 was billed by 23 providers across 10K claims, totaling $280K in Medicaid payments from 2018–2024. This code was used for 8K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$12.41

Providers Billing

National Spending

$280K

Avg/Median Ratio

1.74×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for A6261

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Byram Healthcare Centers, Inc. Torrance, CA · Durable Medical Equipment & Medical Supplies	$78K	$68.19	5.5× median	Top 10%
2	1548367063	$61K	$15.16	1.2× median	Above Median
3	1699756221	$50K	$96.60	7.8× median	Top 1%
4	Byram Healthcare Centers, Inc. Downers Grove, IL · Durable Medical Equipment & Medical Supplies	$38K	$32.83	2.6× median	Above 75th
5	1710932173	$22K	$85.35	6.9× median	Top 10%
6	1427139641	$8K	$23.99	1.9× median	Above Median
7	Orlando Health Inc. Orlando, FL · General Acute Care Hospital	$8K	$27.34	2.2× median	Above 75th
8	1295800068	$6K	$21.66	1.7× median	Above Median
9	H & H Drug Stores, Inc Glendale, CA · Durable Medical Equipment & Medical Supplies	$3K	$17.17	1.4× median	Above Median
10	1962515783	$2K	$9.09	0.7× median	Below Median
11	Byram Healthcare Centers, Inc. Portland, OR · Durable Medical Equipment & Medical Supplies	$2K	$38.70	3.1× median	Above 75th
12	1386688414	$1K	$13.42	1.1× median	Above Median
13	Presbyterian Healthcare Services Albuquerque, NM · Emergency Medicine	$650	$1.60	0.1× median	Below Median
14	1710452701	$280	$2.74	0.2× median	Below Median
15	1275944514	$218	$3.11	0.3× median	Below Median
16	Home Care Delivered, Inc. Richmond, VA · Durable Medical Equipment & Medical Supplies	$194	$11.39	0.9× median	Below Median
17	State Of Mississippi - University Of Mississippi Medical Center Jackson, MS · General Acute Care Hospital	$85	$0.92	0.1× median	Below Median
18	1598053332	$58	$0.97	0.1× median	Below Median
19	1275703084	$44	$2.47	0.2× median	Below Median
20	1376916379	$28	$0.13	0.0× median	Below Median

Showing top 20 of 23 providers billing this code

Related Procedures

A6252$27.8M A6253$21.9M A6258$9.0M A6257$8.9M A6266$6.2M

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