#2434 of 11K

T4542

HCPCS Procedure Code

HCPCS code T4542 is the #2,434 most-billed Medicaid procedure code, with $5.8M in payments across 219K claims from 2018–2024. The national median cost per claim is $33.31.

Total Paid

$5.8M

0.00% of all spending

Total Claims

219K

Providers

100

Avg Cost/Claim

$27

National Cost Distribution

How much do providers bill per claim for T4542? Based on 97 providers billing this code nationally.

Median

$33.31

Average

$32.22

Std Dev

$15.74

Max

$103.38

Percentile Distribution (Cost per Claim)

p10

$12.85

p25

$21.38

Median

$33.31

p75

$39.50

p90

$46.54

p95

$54.84

p99

$82.74

50% of providers bill between $21.38 and $39.50 per claim for this code.

90% bill between $12.85 and $46.54.

Top 1% bill above $82.74.

About This Procedure

HCPCS code T4542 was billed by 100 providers across 219K claims, totaling $5.8M in Medicaid payments from 2018–2024. This code was used for 203K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$33.31

Providers Billing

National Spending

$5.8M

Avg/Median Ratio

0.97×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for T4542

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1700958196	$706K	$34.93	1.0× median	Above Median
2	Rgh Enterprises, Llc Twinsburg, OH · Prosthetic/Orthotic Supplier	$467K	$12.79	0.4× median	Below Median
3	1770606022	$329K	$38.25	1.1× median	Above Median
4	1811972649	$318K	$33.14	1.0× median	Below Median
5	1215262738	$225K	$19.65	0.6× median	Below Median
6	1689752081	$223K	$33.75	1.0× median	Above Median
7	1720033913	$195K	$35.75	1.1× median	Above Median
8	1588780753	$182K	$37.88	1.1× median	Above Median
9	1760446538	$164K	$23.66	0.7× median	Below Median
10	1477939387	$155K	$35.18	1.1× median	Above Median
11	1306962444	$145K	$39.33	1.2× median	Above Median
12	1679696934	$140K	$40.09	1.2× median	Above 75th
13	1548229610	$106K	$36.39	1.1× median	Above Median
14	Medline Industries, Lp Grayslake, IL · Durable Medical Equipment & Medical Supplies	$100K	$19.66	0.6× median	Below Median
15	1558458489	$99K	$50.85	1.5× median	Top 10%
16	1588994438	$99K	$33.31	1.0× median	Above Median
17	1326140138	$96K	$63.85	1.9× median	Top 10%
18	1629213418	$95K	$61.46	1.8× median	Top 10%
19	1578605341	$94K	$30.26	0.9× median	Below Median
20	1093838351	$87K	$36.04	1.1× median	Above Median

Showing top 20 of 100 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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