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

#7589 of 11K

Q0243

HCPCS Procedure Code

HCPCS code Q0243 is the #7,589 most-billed Medicaid procedure code, with $14K in payments across 5,192 claims from 2018–2024. The national median cost per claim is $0.01. Costs vary widely — the 90th percentile is $19.86 per claim, 1986.0× the median.

Total Paid

$14K

0.00% of all spending

Total Claims

5,192

Providers

92

Avg Cost/Claim

$3

National Cost Distribution

How much do providers bill per claim for Q0243? Based on 40 providers billing this code nationally.

Median

$0.01

Average

$7.78

Std Dev

$23.10

Max

$139.99

Percentile Distribution (Cost per Claim)

p10
$0.00
p25
$0.00
Median
$0.01
p75
$7.40
p90
$19.86
p95
$31.18
p99
$98.28

50% of providers bill between $0.00 and $7.40 per claim for this code.

90% bill between $0.00 and $19.86.

Top 1% bill above $98.28.

About This Procedure

HCPCS code Q0243 was billed by 92 providers across 5,192 claims, totaling $14K in Medicaid payments from 2018–2024. This code was used for 3,877 unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$0.01

Providers Billing

40

National Spending

$14K

Avg/Median Ratio

778.00×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for Q0243

#ProviderTotal Paid
1Aurora Health Care Metro, Inc.

Milwaukee, WI · Internal Medicine, Hematology & Oncology

$3K
2Froedtert Memorial Lutheran Hospital, Inc.

Milwaukee, WI · Clinic/Center, Radiology

$3K
31063495836$2K
41780694372$2K
51265740195$1K
61225033020$512
71104890714$470
81750788238$364
91225156888$289
101497352587$270
111780667923$216
121902865355$163
131043279565$162
14San Juan Regional Medical Center, Inc.

Farmington, NM · Audiologist

$76
15Ohio State University Hospitals

Columbus, OH · General Acute Care Hospital

$1
161881695146$1
171558364802$0
18Montefiore Medical Center

Bronx, NY · General Acute Care Hospital

$0
191487647590$0
201841253937$0

Showing top 20 of 92 providers billing this code