#3745 of 11K

00635

HCPCS Procedure Code

HCPCS code 00635 is the #3,745 most-billed Medicaid procedure code, with $1.2M in payments across 13K claims from 2018–2024. The national median cost per claim is $109.11. Costs vary widely — the 90th percentile is $245.20 per claim, 2.2× the median.

Total Paid

$1.2M

0.00% of all spending

Total Claims

13K

Providers

Avg Cost/Claim

$92

National Cost Distribution

How much do providers bill per claim for 00635? Based on 47 providers billing this code nationally.

Median

$109.11

Average

$126.05

Std Dev

$129.91

Max

$816.51

Percentile Distribution (Cost per Claim)

p10

$23.73

p25

$42.93

Median

$109.11

p75

$151.33

p90

$245.20

p95

$295.10

p99

$584.43

50% of providers bill between $42.93 and $151.33 per claim for this code.

90% bill between $23.73 and $245.20.

Top 1% bill above $584.43.

About This Procedure

HCPCS code 00635 was billed by 48 providers across 13K claims, totaling $1.2M in Medicaid payments from 2018–2024. This code was used for 11K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$109.11

Providers Billing

National Spending

$1.2M

Avg/Median Ratio

1.16×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 00635

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1700837408	$165K	$172.88	1.6× median	Above 75th
2	1649264706	$104K	$109.11	1.0× median	Above Median
3	1376741918	$90K	$101.94	0.9× median	Below Median
4	1558588871	$87K	$115.71	1.1× median	Above Median
5	Spectrum Health Primary Care Partners Grand Rapids, MI · Psychologist, Clinical Child & Adolescent	$77K	$59.72	0.5× median	Below Median
6	1356377576	$74K	$124.08	1.1× median	Above Median
7	1417401266	$72K	$230.70	2.1× median	Above 75th
8	1285660704	$58K	$171.32	1.6× median	Above 75th
9	1053354233	$58K	$111.44	1.0× median	Above Median
10	1417965799	$56K	$187.69	1.7× median	Above 75th
11	1427093863	$51K	$41.20	0.4× median	Below Median
12	1336482256	$50K	$125.85	1.2× median	Above Median
13	Vanderbilt University Medical Center Nashville, TN · Transplant Surgery	$36K	$158.86	1.5× median	Above 75th
14	1093767766	$28K	$35.58	0.3× median	Below Median
15	1457666828	$26K	$34.29	0.3× median	Below Median
16	1528010428	$25K	$34.11	0.3× median	Below Median
17	The Nemours Foundation Wilmington, DE · Clinic/Center, Developmental Disabilities	$25K	$294.98	2.7× median	Top 10%
18	1255449963	$24K	$113.32	1.0× median	Above Median
19	1447331038	$13K	$127.22	1.2× median	Above Median
20	1194153650	$11K	$150.37	1.4× median	Above Median

Showing top 20 of 48 providers billing this code

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