#4481 of 11K

G0425

HCPCS Procedure Code

HCPCS code G0425 is the #4,481 most-billed Medicaid procedure code, with $560K in payments across 16K claims from 2018–2024. The national median cost per claim is $26.30. Costs vary widely — the 90th percentile is $86.75 per claim, 3.3× the median.

Total Paid

$560K

0.00% of all spending

Total Claims

16K

Providers

Avg Cost/Claim

$35

National Cost Distribution

How much do providers bill per claim for G0425? Based on 75 providers billing this code nationally.

Median

$26.30

Average

$37.35

Std Dev

$32.52

Max

$107.42

Percentile Distribution (Cost per Claim)

p10

$3.37

p25

$7.29

Median

$26.30

p75

$62.82

p90

$86.75

p95

$96.39

p99

$102.19

50% of providers bill between $7.29 and $62.82 per claim for this code.

90% bill between $3.37 and $86.75.

Top 1% bill above $102.19.

About This Procedure

HCPCS code G0425 was billed by 88 providers across 16K claims, totaling $560K in Medicaid payments from 2018–2024. This code was used for 13K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$26.30

Providers Billing

National Spending

$560K

Avg/Median Ratio

1.42×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for G0425

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1447334750	$180K	$36.43	1.4× median	Above Median
2	1871955807	$58K	$27.95	1.1× median	Above Median
3	1790286193	$55K	$69.29	2.6× median	Above 75th
4	1538397120	$26K	$49.30	1.9× median	Above Median
5	1669510954	$25K	$96.06	3.7× median	Top 10%
6	1710253737	$24K	$70.82	2.7× median	Above 75th
7	Legacy Clinics Llc Portland, OR	$24K	$46.80	1.8× median	Above Median
8	1942369145	$23K	$100.35	3.8× median	Top 10%
9	The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital	$18K	$54.01	2.1× median	Above Median
10	1740415587	$18K	$107.42	4.1× median	Top 1%
11	1245222454	$13K	$87.57	3.3× median	Top 10%
12	1598776452	$7K	$60.28	2.3× median	Above Median
13	1114901725	$6K	$99.42	3.8× median	Top 10%
14	1982142527	$6K	$37.60	1.4× median	Above Median
15	1922145606	$5K	$21.79	0.8× median	Below Median
16	1053343004	$5K	$42.02	1.6× median	Above Median
17	1548271018	$4K	$91.43	3.5× median	Top 10%
18	1275948994	$4K	$5.38	0.2× median	Below Median
19	1396783379	$4K	$33.67	1.3× median	Above Median
20	1629046735	$4K	$85.52	3.3× median	Above 75th

Showing top 20 of 88 providers billing this code

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G0434$1.0M G0433Drug screening, definitive, per date of service$937K G0432$899K G0422$665K G0427$567K

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