#3899 of 11K

E0243

HCPCS Procedure Code

HCPCS code E0243 is the #3,899 most-billed Medicaid procedure code, with $1.0M in payments across 25K claims from 2018–2024. The national median cost per claim is $48.72.

Total Paid

$1.0M

0.00% of all spending

Total Claims

25K

Providers

Avg Cost/Claim

$41

National Cost Distribution

How much do providers bill per claim for E0243? Based on 47 providers billing this code nationally.

Median

$48.72

Average

$48.49

Std Dev

$25.62

Max

$140.18

Percentile Distribution (Cost per Claim)

p10

$24.13

p25

$31.27

Median

$48.72

p75

$56.12

p90

$68.05

p95

$93.27

p99

$136.03

50% of providers bill between $31.27 and $56.12 per claim for this code.

90% bill between $24.13 and $68.05.

Top 1% bill above $136.03.

About This Procedure

HCPCS code E0243 was billed by 48 providers across 25K claims, totaling $1.0M in Medicaid payments from 2018–2024. This code was used for 24K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$48.72

Providers Billing

National Spending

$1.0M

Avg/Median Ratio

1.00×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for E0243

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Integra Partners Llc Troy, MI · Orthotic Fitter	$192K	$30.90	0.6× median	Below Median
2	1093716334	$105K	$56.31	1.2× median	Above 75th
3	1447567334	$103K	$50.75	1.0× median	Above Median
4	Med Star Surgical & Breathing Equipment Inc. Bronx, NY · Prosthetic/Orthotic Supplier	$82K	$32.84	0.7× median	Below Median
5	1750316055	$82K	$59.43	1.2× median	Above 75th
6	1144207911	$67K	$49.32	1.0× median	Above Median
7	1144358839	$58K	$63.60	1.3× median	Above 75th
8	Tenderheart Health Outcomes, Inc. Austin, TX · Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition	$50K	$54.96	1.1× median	Above Median
9	1669570172	$47K	$103.17	2.1× median	Top 10%
10	1235372848	$36K	$32.14	0.7× median	Below Median
11	1245387943	$34K	$131.15	2.7× median	Top 10%
12	1346248341	$28K	$31.46	0.6× median	Below Median
13	Apria Healthcare Llc Indianapolis, IN · Durable Medical Equipment & Medical Supplies	$19K	$29.12	0.6× median	Below Median
14	H & H Drug Stores, Inc Glendale, CA · Durable Medical Equipment & Medical Supplies	$15K	$24.43	0.5× median	Below Median
15	1306990619	$13K	$53.32	1.1× median	Above Median
16	1346265212	$12K	$51.81	1.1× median	Above Median
17	1235389347	$11K	$29.84	0.6× median	Below Median
18	Medline Industries, Lp Grayslake, IL · Durable Medical Equipment & Medical Supplies	$10K	$25.82	0.5× median	Below Median
19	1336736115	$8K	$38.38	0.8× median	Below Median
20	1518964469	$7K	$50.52	1.0× median	Above Median

Showing top 20 of 48 providers billing this code

Related Procedures

E0240$42.1M E0245$10.1M E0247$9.3M E0241$7.0M E0244$3.0M

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