#5130 of 11K

K0053

HCPCS Procedure Code

HCPCS code K0053 is the #5,130 most-billed Medicaid procedure code, with $282K in payments across 7,392 claims from 2018–2024. The national median cost per claim is $9.85. Costs vary widely — the 90th percentile is $41.49 per claim, 4.2× the median.

Total Paid

$282K

0.00% of all spending

Total Claims

7,392

Providers

Avg Cost/Claim

$38

National Cost Distribution

How much do providers bill per claim for K0053? Based on 19 providers billing this code nationally.

Median

$9.85

Average

$22.57

Std Dev

$39.25

Max

$171.61

Percentile Distribution (Cost per Claim)

p10

$4.02

p25

$5.50

Median

$9.85

p75

$17.52

p90

$41.49

p95

$79.44

p99

$153.18

50% of providers bill between $5.50 and $17.52 per claim for this code.

90% bill between $4.02 and $41.49.

Top 1% bill above $153.18.

About This Procedure

HCPCS code K0053 was billed by 20 providers across 7,392 claims, totaling $282K in Medicaid payments from 2018–2024. This code was used for 6,518 unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$9.85

Providers Billing

National Spending

$282K

Avg/Median Ratio

2.29×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for K0053

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1518037787	$221K	$171.61	17.4× median	Top 1%
2	1730182023	$14K	$13.94	1.4× median	Above Median
3	Med Star Surgical & Breathing Equipment Inc. Bronx, NY · Prosthetic/Orthotic Supplier	$11K	$5.72	0.6× median	Below Median
4	1033142484	$8K	$34.56	3.5× median	Above 75th
5	1386688414	$6K	$8.45	0.9× median	Below Median
6	1043212871	$4K	$6.40	0.6× median	Below Median
7	1609874072	$4K	$14.12	1.4× median	Above Median
8	1033119730	$4K	$20.78	2.1× median	Above 75th
9	1831289826	$3K	$5.27	0.5× median	Below Median
10	1053400960	$3K	$19.25	2.0× median	Above 75th
11	1588994438	$2K	$69.20	7.0× median	Top 10%
12	1700983947	$2K	$9.85	1.0× median	Below Median
13	1689006587	$525	$3.09	0.3× median	Below Median
14	1851328157	$347	$15.78	1.6× median	Above Median
15	1790881530	$324	$12.47	1.3× median	Above Median
16	1528151701	$145	$4.26	0.4× median	Below Median
17	1003834946	$106	$7.10	0.7× median	Below Median
18	1134303902	$89	$2.07	0.2× median	Below Median
19	H & H Drug Stores, Inc Glendale, CA · Durable Medical Equipment & Medical Supplies	$63	$4.85	0.5× median	Below Median
20	1477594877	$0	$0.00	0.0× median	Below Median

Showing top 20 of 20 providers billing this code

Related Procedures

K0052$39K K0056$38K K0045$18K K0043$9K

← All procedures Top providers →