#1626 of 11K

M0354

HCPCS Procedure Code

HCPCS code M0354 is the #1,626 most-billed Medicaid procedure code, with $17.5M in payments across 179K claims from 2018–2024. The national median cost per claim is $90.61.

Total Paid

$17.5M

0.00% of all spending

Total Claims

179K

Providers

Avg Cost/Claim

$98

National Cost Distribution

How much do providers bill per claim for M0354? Based on 38 providers billing this code nationally.

Median

$90.61

Average

$87.10

Std Dev

$45.46

Max

$165.47

Percentile Distribution (Cost per Claim)

p10

$24.40

p25

$51.37

Median

$90.61

p75

$123.21

p90

$141.78

p95

$158.41

p99

$164.98

50% of providers bill between $51.37 and $123.21 per claim for this code.

90% bill between $24.40 and $141.78.

Top 1% bill above $164.98.

About This Procedure

HCPCS code M0354 was billed by 38 providers across 179K claims, totaling $17.5M in Medicaid payments from 2018–2024. This code was used for 10K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$90.61

Providers Billing

National Spending

$17.5M

Avg/Median Ratio

0.96×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for M0354

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Berry Family Services Rowlett, TX · Case Management	$3.1M	$165.47	1.8× median	Top 1%
2	Wellness Healthcare Solutions Inc. Desoto, TX · Day Training, Developmentally Disabled Services	$1.6M	$157.40	1.7× median	Top 10%
3	1598084774	$1.3M	$126.94	1.4× median	Above 75th
4	1891971297	$1.0M	$164.15	1.8× median	Top 10%
5	Lifetime Living Inc. San Antonio, TX · Case Management	$986K	$98.45	1.1× median	Above Median
6	1710188396	$979K	$143.36	1.6× median	Top 10%
7	Volunteers Of America Texas Inc. Euless, TX · Intermediate Care Facility Intellectual Disabilities	$750K	$122.80	1.4× median	Above Median
8	1518062520	$673K	$90.58	1.0× median	Below Median
9	1710014618	$613K	$121.94	1.3× median	Above Median
10	Daybreak Community Services Texas Llc Fort Worth, TX · Community Based Residential Treatment Facility Intellectual and/or Developmental Disabilities	$578K	$102.47	1.1× median	Above Median
11	1952526576	$562K	$63.89	0.7× median	Below Median
12	D&s Residential Services, Lp Austin, TX · Intermediate Care Facility, Intellectual Disabilities	$562K	$134.78	1.5× median	Above 75th
13	Texana Center Rosenberg, TX · Counselor, Mental Health	$541K	$85.06	0.9× median	Below Median
14	1215264627	$496K	$141.10	1.6× median	Above 75th
15	1093916835	$453K	$93.90	1.0× median	Above Median
16	1992836936	$405K	$74.33	0.8× median	Below Median
17	1861709586	$357K	$126.86	1.4× median	Above 75th
18	1578576310	$270K	$124.72	1.4× median	Above 75th
19	1629185566	$262K	$65.03	0.7× median	Below Median
20	1811906977	$239K	$61.57	0.7× median	Below Median

Showing top 20 of 38 providers billing this code

Related Procedures

M0355$69.0M M0361$29.2M M0360$21.1M M0347$838K M0359$56K

← All procedures Top providers →