#3071 of 11K

S5501

HCPCS Procedure Code

HCPCS code S5501 is the #3,071 most-billed Medicaid procedure code, with $2.6M in payments across 58K claims from 2018–2024. The national median cost per claim is $43.74. Costs vary widely — the 90th percentile is $154.11 per claim, 3.5× the median.

Total Paid

$2.6M

0.00% of all spending

Total Claims

58K

Providers

Avg Cost/Claim

$45

National Cost Distribution

How much do providers bill per claim for S5501? Based on 35 providers billing this code nationally.

Median

$43.74

Average

$68.27

Std Dev

$61.11

Max

$260.91

Percentile Distribution (Cost per Claim)

p10

$12.32

p25

$24.34

Median

$43.74

p75

$107.10

p90

$154.11

p95

$170.88

p99

$232.63

50% of providers bill between $24.34 and $107.10 per claim for this code.

90% bill between $12.32 and $154.11.

Top 1% bill above $232.63.

About This Procedure

HCPCS code S5501 was billed by 35 providers across 58K claims, totaling $2.6M in Medicaid payments from 2018–2024. This code was used for 19K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$43.74

Providers Billing

National Spending

$2.6M

Avg/Median Ratio

1.56×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for S5501

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1346270527	$353K	$41.38	0.9× median	Below Median
2	1750396461	$316K	$39.66	0.9× median	Below Median
3	1417472812	$265K	$106.88	2.4× median	Above Median
4	1881727998	$237K	$54.76	1.3× median	Above Median
5	1033166244	$225K	$151.32	3.5× median	Above 75th
6	1083793566	$213K	$113.05	2.6× median	Above 75th
7	1255336517	$169K	$14.55	0.3× median	Below Median
8	Optum Infusion Services 308 Llc Chandler, AZ · Pharmacy Home Infusion Therapy Pharmacy	$148K	$155.98	3.6× median	Top 10%
9	1417904574	$110K	$167.94	3.8× median	Top 10%
10	1295707933	$105K	$34.24	0.8× median	Below Median
11	1245207380	$95K	$41.25	0.9× median	Below Median
12	1114099488	$60K	$260.91	6.0× median	Top 1%
13	1619478047	$52K	$49.05	1.1× median	Above Median
14	1750378436	$51K	$43.95	1.0× median	Above Median
15	1326096629	$37K	$28.54	0.7× median	Below Median
16	1154418218	$34K	$6.69	0.2× median	Below Median
17	1952301897	$26K	$102.98	2.4× median	Above Median
18	1831241033	$17K	$26.33	0.6× median	Below Median
19	1184653388	$16K	$62.98	1.4× median	Above Median
20	1619970845	$10K	$40.62	0.9× median	Below Median

Showing top 20 of 35 providers billing this code

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