#1586 of 11K

T4540

HCPCS Procedure Code

HCPCS code T4540 is the #1,586 most-billed Medicaid procedure code, with $18.4M in payments across 870K claims from 2018–2024. The national median cost per claim is $17.85. Costs vary widely — the 90th percentile is $49.95 per claim, 2.8× the median.

Total Paid

$18.4M

0.00% of all spending

Total Claims

870K

Providers

177

Avg Cost/Claim

$21

National Cost Distribution

How much do providers bill per claim for T4540? Based on 175 providers billing this code nationally.

Median

$17.85

Average

$25.67

Std Dev

$22.00

Max

$156.42

Percentile Distribution (Cost per Claim)

p10

$12.73

p25

$14.31

Median

$17.85

p75

$28.08

p90

$49.95

p95

$53.75

p99

$133.25

50% of providers bill between $14.31 and $28.08 per claim for this code.

90% bill between $12.73 and $49.95.

Top 1% bill above $133.25.

About This Procedure

HCPCS code T4540 was billed by 177 providers across 870K claims, totaling $18.4M in Medicaid payments from 2018–2024. This code was used for 851K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$17.85

Providers Billing

175

National Spending

$18.4M

Avg/Median Ratio

1.44×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for T4540

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1922071034	$1.5M	$31.45	1.8× median	Above 75th
2	1639151103	$1.4M	$17.96	1.0× median	Above Median
3	Activstyle, Llc Saint Paul, MN · Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition	$1.4M	$21.00	1.2× median	Above Median
4	Integra Partners Llc Troy, MI · Orthotic Fitter	$1.3M	$17.39	1.0× median	Below Median
5	1538254461	$922K	$16.92	0.9× median	Below Median
6	1346248341	$910K	$50.69	2.8× median	Top 10%
7	1164944641	$646K	$31.00	1.7× median	Above 75th
8	1992975700	$543K	$53.39	3.0× median	Top 10%
9	1013169762	$530K	$30.39	1.7× median	Above 75th
10	1447474010	$509K	$16.41	0.9× median	Below Median
11	Medcare Equipment Company, Llc Export, PA · Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies	$459K	$39.56	2.2× median	Above 75th
12	Med Star Surgical & Breathing Equipment Inc. Bronx, NY · Prosthetic/Orthotic Supplier	$349K	$12.30	0.7× median	Below Median
13	1245387943	$327K	$16.20	0.9× median	Below Median
14	1356398796	$327K	$50.13	2.8× median	Top 10%
15	1437348596	$308K	$17.41	1.0× median	Below Median
16	1649244138	$260K	$13.48	0.8× median	Below Median
17	1013367697	$242K	$17.84	1.0× median	Below Median
18	1649383084	$228K	$18.69	1.0× median	Above Median
19	1225023922	$227K	$24.72	1.4× median	Above Median
20	1093716334	$224K	$14.20	0.8× median	Below Median

Showing top 20 of 177 providers billing this code

Related Procedures

T4535Adult-sized disposable underpads/pads, large$850.8M T4541Pediatric-sized disposable incontinence product, large$757.4M T4534Adult-sized disposable underpads/pads, small$369.6M T4543Pediatric-sized disposable incontinence product, above XL$197.9M T4544Pediatric-sized disposable underpads/pads, small$186.9M

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