#4098 of 11K

L5940

HCPCS Procedure Code

HCPCS code L5940 is the #4,098 most-billed Medicaid procedure code, with $851K in payments across 3,969 claims from 2018–2024. The national median cost per claim is $185.49.

Total Paid

$851K

0.00% of all spending

Total Claims

3,969

Providers

Avg Cost/Claim

$215

National Cost Distribution

How much do providers bill per claim for L5940? Based on 37 providers billing this code nationally.

Median

$185.49

Average

$213.43

Std Dev

$122.82

Max

$668.52

Percentile Distribution (Cost per Claim)

p10

$115.52

p25

$133.62

Median

$185.49

p75

$252.23

p90

$328.60

p95

$452.05

p99

$602.74

50% of providers bill between $133.62 and $252.23 per claim for this code.

90% bill between $115.52 and $328.60.

Top 1% bill above $602.74.

About This Procedure

HCPCS code L5940 was billed by 38 providers across 3,969 claims, totaling $851K in Medicaid payments from 2018–2024. This code was used for 3,488 unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$185.49

Providers Billing

National Spending

$851K

Avg/Median Ratio

1.15×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for L5940

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1427179753	$161K	$255.19	1.4× median	Above 75th
2	Integra Partners Llc Troy, MI · Orthotic Fitter	$148K	$350.26	1.9× median	Top 10%
3	1326048893	$95K	$238.91	1.3× median	Above Median
4	1164586103	$51K	$237.98	1.3× median	Above Median
5	1003980988	$44K	$314.16	1.7× median	Above 75th
6	1174573307	$36K	$310.92	1.7× median	Above 75th
7	1134127061	$28K	$131.04	0.7× median	Below Median
8	1790787018	$26K	$137.60	0.7× median	Below Median
9	1386730554	$25K	$443.62	2.4× median	Top 10%
10	1184607335	$24K	$71.44	0.4× median	Below Median
11	1417692369	$22K	$668.52	3.6× median	Top 1%
12	1215134986	$17K	$131.14	0.7× median	Below Median
13	1548482128	$16K	$124.35	0.7× median	Below Median
14	1629258991	$16K	$141.58	0.8× median	Below Median
15	1417021304	$15K	$132.55	0.7× median	Below Median
16	1679570238	$15K	$202.62	1.1× median	Above Median
17	1982615712	$14K	$221.13	1.2× median	Above Median
18	1881616720	$11K	$106.61	0.6× median	Below Median
19	1083788137	$11K	$225.16	1.2× median	Above Median
20	1598859282	$11K	$194.76	1.0× median	Above Median

Showing top 20 of 38 providers billing this code

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