#1467 of 11K

00790

HCPCS Procedure Code

HCPCS code 00790 is the #1,467 most-billed Medicaid procedure code, with $22.2M in payments across 175K claims from 2018–2024. The national median cost per claim is $115.06. Costs vary widely — the 90th percentile is $285.33 per claim, 2.5× the median.

Total Paid

$22.2M

0.00% of all spending

Total Claims

175K

Providers

350

Avg Cost/Claim

$127

National Cost Distribution

How much do providers bill per claim for 00790? Based on 308 providers billing this code nationally.

Median

$115.06

Average

$142.98

Std Dev

$128.27

Max

$1,073.35

Percentile Distribution (Cost per Claim)

p10

$18.30

p25

$69.69

Median

$115.06

p75

$184.12

p90

$285.33

p95

$390.11

p99

$593.93

50% of providers bill between $69.69 and $184.12 per claim for this code.

90% bill between $18.30 and $285.33.

Top 1% bill above $593.93.

About This Procedure

HCPCS code 00790 was billed by 350 providers across 175K claims, totaling $22.2M in Medicaid payments from 2018–2024. This code was used for 137K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$115.06

Providers Billing

308

National Spending

$22.2M

Avg/Median Ratio

1.24×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 00790

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1053354233	$2.0M	$467.95	4.1× median	Top 10%
2	1558314427	$1.1M	$163.45	1.4× median	Above Median
3	1225016926	$893K	$98.61	0.9× median	Below Median
4	1487602546	$784K	$549.57	4.8× median	Top 10%
5	1346267267	$776K	$200.28	1.7× median	Above 75th
6	1972126209	$598K	$80.47	0.7× median	Below Median
7	1558391763	$597K	$285.89	2.5× median	Top 10%
8	1871986372	$553K	$98.97	0.9× median	Below Median
9	1417994872	$523K	$107.84	0.9× median	Below Median
10	1053366377	$509K	$135.55	1.2× median	Above Median
11	1407821796	$495K	$101.55	0.9× median	Below Median
12	1093767766	$472K	$146.90	1.3× median	Above Median
13	1669581997	$462K	$79.06	0.7× median	Below Median
14	West Virginia University Medical Corporation Morgantown, WV · Anesthesiology	$374K	$218.37	1.9× median	Above 75th
15	1508138256	$372K	$231.01	2.0× median	Above 75th
16	1811997869	$360K	$172.18	1.5× median	Above Median
17	1497797153	$348K	$72.24	0.6× median	Below Median
18	1003989690	$326K	$135.51	1.2× median	Above Median
19	1952392946	$323K	$409.95	3.6× median	Top 10%
20	1710324041	$312K	$323.41	2.8× median	Top 10%

Showing top 20 of 350 providers billing this code

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