#4156 of 11K

0420

HCPCS Procedure Code

HCPCS code 0420 is the #4,156 most-billed Medicaid procedure code, with $799K in payments across 56K claims from 2018–2024. The national median cost per claim is $23.66. Costs vary widely — the 90th percentile is $123.89 per claim, 5.2× the median.

Total Paid

$799K

0.00% of all spending

Total Claims

56K

Providers

106

Avg Cost/Claim

$14

National Cost Distribution

How much do providers bill per claim for 0420? Based on 48 providers billing this code nationally.

Median

$23.66

Average

$87.68

Std Dev

$267.21

Max

$1,802.88

Percentile Distribution (Cost per Claim)

p10

$0.62

p25

$6.50

Median

$23.66

p75

$62.89

p90

$123.89

p95

$259.89

p99

$1,188.28

50% of providers bill between $6.50 and $62.89 per claim for this code.

90% bill between $0.62 and $123.89.

Top 1% bill above $1,188.28.

About This Procedure

HCPCS code 0420 was billed by 106 providers across 56K claims, totaling $799K in Medicaid payments from 2018–2024. This code was used for 33K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$23.66

Providers Billing

National Spending

$799K

Avg/Median Ratio

3.71×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for 0420

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1194840421	$167K	$72.87	3.1× median	Above 75th
2	1447817721	$121K	$85.53	3.6× median	Above 75th
3	1114367497	$70K	$41.25	1.7× median	Above Median
4	1225038136	$59K	$33.85	1.4× median	Above Median
5	Grossmont Hospital Corporation La Mesa, CA · General Acute Care Hospital	$39K	$109.70	4.6× median	Above 75th
6	1972201598	$38K	$1,802.88	76.2× median	Top 1%
7	1831188275	$33K	$15.59	0.7× median	Below Median
8	Palomar Health Escondido, CA · General Acute Care Hospital	$32K	$93.83	4.0× median	Above 75th
9	County Of Ventura Ventura, CA · Clinic/Center, Emergency Care	$30K	$25.30	1.1× median	Above Median
10	1063441293	$24K	$17.39	0.7× median	Below Median
11	Sharp Chula Vista Medical Center Chula Vista, CA · General Acute Care Hospital	$21K	$181.59	7.7× median	Top 10%
12	1487681631	$18K	$302.05	12.8× median	Top 10%
13	1215927470	$15K	$24.37	1.0× median	Above Median
14	1477610640	$13K	$11.02	0.5× median	Below Median
15	1215903018	$11K	$54.79	2.3× median	Above Median
16	Childrens Hospital Of Los Angeles Los Angeles, CA · Case Manager/Care Coordinator	$11K	$26.14	1.1× median	Above Median
17	1558915256	$9K	$7.61	0.3× median	Below Median
18	University Of California Irvine Orange, CA · General Acute Care Hospital	$9K	$37.20	1.6× median	Above Median
19	1508959214	$8K	$495.22	20.9× median	Top 10%
20	1477596583	$8K	$60.82	2.6× median	Above Median

Showing top 20 of 106 providers billing this code

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