#2350 of 11K

11055

HCPCS Procedure Code

HCPCS code 11055 is the #2,350 most-billed Medicaid procedure code, with $6.5M in payments across 713K claims from 2018–2024. The national median cost per claim is $7.46. Costs vary widely — the 90th percentile is $28.48 per claim, 3.8× the median.

Total Paid

$6.5M

0.00% of all spending

Total Claims

713K

Providers

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for 11055? Based on 994 providers billing this code nationally.

Median

$7.46

Average

$14.23

Std Dev

$26.41

Max

$351.21

Percentile Distribution (Cost per Claim)

p10

$1.14

p25

$3.09

Median

$7.46

p75

$14.97

p90

$28.48

p95

$44.18

p99

$144.04

50% of providers bill between $3.09 and $14.97 per claim for this code.

90% bill between $1.14 and $28.48.

Top 1% bill above $144.04.

About This Procedure

HCPCS code 11055 was billed by 1K providers across 713K claims, totaling $6.5M in Medicaid payments from 2018–2024. This code was used for 636K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$7.46

Providers Billing

994

National Spending

$6.5M

Avg/Median Ratio

1.91×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for 11055

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1083962294	$582K	$28.90	3.9× median	Top 10%
2	1720037138	$426K	$5.18	0.7× median	Below Median
3	The Metrohealth System Cleveland, OH · General Acute Care Hospital	$342K	$140.73	18.9× median	Top 10%
4	1689613598	$327K	$7.07	0.9× median	Below Median
5	Boston Medical Center Corporation Boston, MA · General Acute Care Hospital	$253K	$131.47	17.6× median	Top 10%
6	1003066747	$178K	$9.91	1.3× median	Above Median
7	1487654042	$146K	$6.15	0.8× median	Below Median
8	University Hospital Newark, NJ · General Acute Care Hospital	$118K	$74.71	10.0× median	Top 10%
9	1174615173	$104K	$22.86	3.1× median	Above 75th
10	The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital	$81K	$107.08	14.4× median	Top 10%
11	1871822213	$81K	$8.04	1.1× median	Above Median
12	1821284506	$75K	$7.89	1.1× median	Above Median
13	1720058928	$73K	$31.33	4.2× median	Top 10%
14	1417251935	$67K	$40.15	5.4× median	Top 10%
15	1679504427	$67K	$8.22	1.1× median	Above Median
16	1356443337	$66K	$7.15	1.0× median	Below Median
17	Maricopa County Special Health Care District Phoenix, AZ · General Acute Care Hospital	$64K	$127.45	17.1× median	Top 10%
18	1881882116	$64K	$4.59	0.6× median	Below Median
19	1063480218	$58K	$37.61	5.0× median	Top 10%
20	1053357244	$57K	$117.19	15.7× median	Top 10%

Showing top 20 of 1K providers billing this code

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