54161
HCPCS Procedure Code
HCPCS code 54161 is the #814 most-billed Medicaid procedure code, with $74.0M in payments across 125K claims from 2018–2024. The national median cost per claim is $252.63. Costs vary widely — the 90th percentile is $1,321.01 per claim, 5.2× the median.
Total Paid
$74.0M
0.01% of all spending
Total Claims
125K
Providers
359
Avg Cost/Claim
$592
National Cost Distribution
How much do providers bill per claim for 54161? Based on 355 providers billing this code nationally.
Median
$252.63
Average
$557.81
Std Dev
$623.98
Max
$3,288.12
Percentile Distribution (Cost per Claim)
50% of providers bill between $136.70 and $847.72 per claim for this code.
90% bill between $103.30 and $1,321.01.
Top 1% bill above $2,837.40.
About This Procedure
HCPCS code 54161 was billed by 359 providers across 125K claims, totaling $74.0M in Medicaid payments from 2018–2024. This code was used for 117K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$252.63
Providers Billing
355
National Spending
$74.0M
Avg/Median Ratio
2.21×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for 54161
| # | Provider | Total Paid |
|---|---|---|
| 1 | Phoenix Children's Hospital Phoenix, AZ · General Acute Care Hospital Children | $8.4M |
| 2 | Southern Baptist Hospital Of Florida Inc Jacksonville, FL · General Acute Care Hospital Children | $2.5M |
| 3 | State Of Mississippi - University Of Mississippi Medical Center Jackson, MS · General Acute Care Hospital | $2.5M |
| 4 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $2.1M |
| 5 | Children's Hospital Corporation Boston, MA · Clinic/Center | $2.1M |
| 6 | 1699874248 | $2.0M |
| 7 | Scottish Rite Children's Medical Center Atlanta, GA · Pediatrics Pediatric Hematology-Oncology | $1.8M |
| 8 | Seattle Children's Hospital Seattle, WA · Prosthetic/Orthotic Supplier | $1.8M |
| 9 | 1861439952 | $1.7M |
| 10 | Maimonides Medical Center Brooklyn, NY · General Acute Care Hospital | $1.6M |
| 11 | Newark Beth Israel Medical Center Inc Newark, NJ · General Acute Care Hospital | $1.5M |
| 12 | Connecticut Children's Medical Center Hartford, CT · General Acute Care Hospital, Children | $1.5M |
| 13 | Childrens Hospital Of The Kings Daughters Inc Norfolk, VA · Social Worker, Clinical | $1.3M |
| 14 | Vhs Childrens Hospital Of Michigan Inc Detroit, MI · Clinic/Center, Ambulatory Surgical | $1.2M |
| 15 | Children's Hospital Washington, DC · General Acute Care Hospital Children | $1.1M |
| 16 | University Of Kentucky Lexington, KY · General Acute Care Hospital | $1.1M |
| 17 | Southern Baptist Hospital Of Florida Inc Jacksonville, FL · General Acute Care Hospital | $983K |
| 18 | Orlando Health Inc. Orlando, FL · General Acute Care Hospital | $960K |
| 19 | Tucson Medical Center Tucson, AZ · Clinic/Center, Hearing and Speech | $952K |
| 20 | Childrens Hospital Of Philadelphia Philadelphia, PA · General Acute Care Hospital Children | $881K |
Showing top 20 of 359 providers billing this code