#5982 of 11K

0403

HCPCS Procedure Code

HCPCS code 0403 is the #5,982 most-billed Medicaid procedure code, with $110K in payments across 5K claims from 2018–2024. The national median cost per claim is $66.37. Costs vary widely — the 90th percentile is $137.31 per claim, 2.1× the median.

Total Paid

$110K

0.00% of all spending

Total Claims

Providers

Avg Cost/Claim

$21

National Cost Distribution

How much do providers bill per claim for 0403? Based on 12 providers billing this code nationally.

Median

$66.37

Average

$73.61

Std Dev

$47.94

Max

$169.61

Percentile Distribution (Cost per Claim)

p10

$17.32

p25

$50.09

Median

$66.37

p75

$94.80

p90

$137.31

p95

$154.34

p99

$166.56

50% of providers bill between $50.09 and $94.80 per claim for this code.

90% bill between $17.32 and $137.31.

Top 1% bill above $166.56.

About This Procedure

HCPCS code 0403 was billed by 20 providers across 5K claims, totaling $110K in Medicaid payments from 2018–2024. This code was used for 3K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$66.37

Providers Billing

National Spending

$110K

Avg/Median Ratio

1.11×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 0403

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1194711952	$58K	$44.33	0.7× median	Below Median
2	1477554152	$15K	$96.48	1.5× median	Above 75th
3	1538141627	$11K	$52.00	0.8× median	Below Median
4	1104906569	$6K	$59.44	0.9× median	Below Median
5	1336167550	$5K	$68.34	1.0× median	Above Median
6	1801366711	$4K	$169.61	2.6× median	Top 1%
7	1639172372	$4K	$141.85	2.1× median	Top 10%
8	1205845567	$3K	$94.23	1.4× median	Above Median
9	1760510937	$2K	$0.85	0.0× median	Below Median
10	1669673646	$2K	$77.53	1.2× median	Above Median
11	1316027709	$1K	$64.39	1.0× median	Below Median
12	1780668434	$859	$14.32	0.2× median	Below Median
13	1992752315	$0	$0.00	0.0× median	Below Median
14	1518951300	$0	$0.00	0.0× median	Below Median
15	1912108002	$0	$0.00	0.0× median	Below Median
16	1194926279	$0	$0.00	0.0× median	Below Median
17	1558575746	$0	$0.00	0.0× median	Below Median
18	Kaiser Foundation Hospitals Anaheim, CA · General Acute Care Hospital	$0	$0.00	0.0× median	Below Median
19	1275576381	$0	$0.00	0.0× median	Below Median
20	1750503017	$0	$0.00	0.0× median	Below Median

Showing top 20 of 20 providers billing this code

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