S5497
HCPCS Procedure Code
HCPCS code S5497 is the #4,121 most-billed Medicaid procedure code, with $830K in payments across 1,963 claims from 2018–2024. The national median cost per claim is $46.31. Costs vary widely — the 90th percentile is $340.26 per claim, 7.3× the median.
Total Paid
$830K
0.00% of all spending
Total Claims
1,963
Providers
5
Avg Cost/Claim
$423
National Cost Distribution
How much do providers bill per claim for S5497? Based on 5 providers billing this code nationally.
Median
$46.31
Average
$137.21
Std Dev
$196.48
Max
$477.32
Percentile Distribution (Cost per Claim)
50% of providers bill between $18.98 and $134.66 per claim for this code.
90% bill between $12.87 and $340.26.
Top 1% bill above $463.62.
About This Procedure
HCPCS code S5497 was billed by 5 providers across 1,963 claims, totaling $830K in Medicaid payments from 2018–2024. This code was used for 1,106 unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$46.31
Providers Billing
5
National Spending
$830K
Avg/Median Ratio
2.96×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for S5497
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1629116645 | $824K |
| 2 | 1992788350 | $2K |
| 3 | 1235209081 | $2K |
| 4 | 1710231733 | $1K |
| 5 | Option Care Enterprises Inc. Tampa, FL · Pharmacy Home Infusion Therapy Pharmacy | $1K |
Showing top 5 of 5 providers billing this code