#5760 of 11K

A7004

HCPCS Procedure Code

HCPCS code A7004 is the #5,760 most-billed Medicaid procedure code, with $144K in payments across 128K claims from 2018–2024. The national median cost per claim is $1.10. Costs vary widely — the 90th percentile is $2.23 per claim, 2.0× the median.

Total Paid

$144K

0.00% of all spending

Total Claims

128K

Providers

148

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for A7004? Based on 131 providers billing this code nationally.

Median

$1.10

Average

$1.19

Std Dev

$0.97

Max

$6.34

Percentile Distribution (Cost per Claim)

p10

$0.17

p25

$0.46

Median

$1.10

p75

$1.49

p90

$2.23

p95

$3.21

p99

$4.27

50% of providers bill between $0.46 and $1.49 per claim for this code.

90% bill between $0.17 and $2.23.

Top 1% bill above $4.27.

About This Procedure

HCPCS code A7004 was billed by 148 providers across 128K claims, totaling $144K in Medicaid payments from 2018–2024. This code was used for 116K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$1.10

Providers Billing

131

National Spending

$144K

Avg/Median Ratio

1.08×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for A7004

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1912060740	$15K	$0.51	0.5× median	Below Median
2	Home Medical Equipment Specialists Llc Albuquerque, NM · Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies	$14K	$1.33	1.2× median	Above Median
3	Los Ninos Hospital Inc Phoenix, AZ · Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies	$14K	$3.21	2.9× median	Top 10%
4	1811097504	$12K	$1.12	1.0× median	Above Median
5	1114943610	$8K	$1.01	0.9× median	Below Median
6	1154479913	$7K	$1.31	1.2× median	Above Median
7	1306961792	$7K	$2.33	2.1× median	Top 10%
8	1164530630	$4K	$2.75	2.5× median	Top 10%
9	1275733206	$4K	$3.59	3.3× median	Top 10%
10	1487939583	$4K	$1.97	1.8× median	Above 75th
11	1366580391	$3K	$2.48	2.3× median	Top 10%
12	1184978181	$3K	$1.46	1.3× median	Above Median
13	1083611867	$3K	$1.72	1.6× median	Above 75th
14	1104990837	$3K	$1.27	1.2× median	Above Median
15	1245383348	$3K	$3.88	3.5× median	Top 10%
16	1346285442	$2K	$1.44	1.3× median	Above Median
17	1093714685	$2K	$3.29	3.0× median	Top 10%
18	1982606851	$2K	$1.57	1.4× median	Above 75th
19	1386925568	$2K	$1.33	1.2× median	Above Median
20	1952353948	$2K	$1.54	1.4× median	Above 75th

Showing top 20 of 148 providers billing this code

Related Procedures

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