U0004
COVID-19 test, nucleic acid detection, CDC lab only
COVID-19 test, nucleic acid detection, CDC lab only is the #227 most-billed Medicaid procedure code, with $675.3M in payments across 11.7M claims from 2018–2024. The national median cost per claim is $60.05.
Total Paid
$675.3M
0.06% of all spending
Total Claims
11.7M
Providers
1K
Avg Cost/Claim
$58
National Cost Distribution
How much do providers bill per claim for U0004? Based on 1K providers billing this code nationally.
Median
$60.05
Average
$58.08
Std Dev
$34.50
Max
$435.66
Percentile Distribution (Cost per Claim)
50% of providers bill between $39.71 and $73.77 per claim for this code.
90% bill between $13.26 and $87.67.
Top 1% bill above $176.32.
About This Procedure
HCPCS code U0004 (COVID-19 test, nucleic acid detection, CDC lab only) was billed by 1K providers across 11.7M claims, totaling $675.3M in Medicaid payments from 2018–2024. This code was used for 7.8M unique beneficiaries.
Fraud Risk Context
COVID-19 testing codes saw massive billing increases during 2020–2022, with the OIG documenting widespread testing fraud.
Source: HHS OIG COVID-19 Reports
Risk Assessment
This procedure is featured in our investigation: COVID Testing Boom
Read the full analysis for context on billing patterns associated with this code.
Billing Statistics
Median Cost/Claim
$60.05
Providers Billing
1K
National Spending
$675.3M
Avg/Median Ratio
0.97×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for U0004
| # | Provider | Total Paid |
|---|---|---|
| 1 | Lifescan Labs Of Illinois Llc Skokie, IL · Clinical Medical Laboratory | $38.4M |
| 2 | Northwell Health Laboratories New Hyde Park, NY · Clinical Medical Laboratory | $18.1M |
| 3 | Sherman Abrams Laboratory Inc Brooklyn, NY · Clinical Medical Laboratory | $18.0M |
| 4 | Acutis Diagnostics Inc Hicksville, NY · Clinical Medical Laboratory | $15.6M |
| 5 | Genesis Laboratory Management, Llc Oakhurst, NJ · Clinical Medical Laboratory | $13.9M |
| 6 | Primex Clinical Laboratories Inc. Van Nuys, CA · Clinical Medical Laboratory | $12.5M |
| 7 | Ridgewood Diagnostic Laboratory, Llc Hackensack, NJ · Clinical Medical Laboratory | $10.0M |
| 8 | Dayton Children's Hospital Dayton, OH · General Acute Care Hospital, Children | $10.0M |
| 9 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $9.3M |
| 10 | Brio Clinical Inc Ontario, CA · Clinic/Center, Radiology, Mobile | $8.9M |
| 11 | Medarbor Llc Bristol, PA · Clinical Medical Laboratory | $8.8M |
| 12 | 1548208440 | $8.8M |
| 13 | Ethos Holding Corp Newport, KY · Clinical Medical Laboratory | $8.1M |
| 14 | 1508326851 | $7.8M |
| 15 | 1982091617 | $7.7M |
| 16 | Infinity Biologix Llc Piscataway, NJ · Clinical Medical Laboratory | $7.7M |
| 17 | 1235234402 | $7.4M |
| 18 | 1881034064 | $6.8M |
| 19 | 1386235125 | $6.4M |
| 20 | Gentech Laboratories Llc Dallas, TX · Clinical Medical Laboratory | $6.3M |
Showing top 20 of 1K providers billing this code