Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

#5541 of 11K

G0416

HCPCS Procedure Code

HCPCS code G0416 is the #5,541 most-billed Medicaid procedure code, with $179K in payments across 1,881 claims from 2018–2024. The national median cost per claim is $39.45. Costs vary widely — the 90th percentile is $333.42 per claim, 8.5× the median.

Total Paid

$179K

0.00% of all spending

Total Claims

1,881

Providers

17

Avg Cost/Claim

$95

National Cost Distribution

How much do providers bill per claim for G0416? Based on 15 providers billing this code nationally.

Median

$39.45

Average

$131.13

Std Dev

$166.47

Max

$569.74

Percentile Distribution (Cost per Claim)

p10
$11.49
p25
$24.71
Median
$39.45
p75
$209.94
p90
$333.42
p95
$424.36
p99
$540.67

50% of providers bill between $24.71 and $209.94 per claim for this code.

90% bill between $11.49 and $333.42.

Top 1% bill above $540.67.

About This Procedure

HCPCS code G0416 was billed by 17 providers across 1,881 claims, totaling $179K in Medicaid payments from 2018–2024. This code was used for 1,619 unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$39.45

Providers Billing

15

National Spending

$179K

Avg/Median Ratio

3.32×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for G0416

#ProviderTotal Paid
11780830737$78K
2A2cl Services, Llc

West Allis, WI · Clinical Medical Laboratory

$31K
31700153921$30K
41912997354$17K
51023006434$7K
6Northwell Health Laboratories

New Hyde Park, NY · Clinical Medical Laboratory

$4K
71124316138$3K
81467546135$3K
91659390763$3K
101467433292$1K
111962481820$825
121063619922$570
131497120653$508
141235215427$166
151588822423$46
161609823004$0
17Boston Medical Center Corporation

Boston, MA · General Acute Care Hospital

$0

Showing top 17 of 17 providers billing this code