#4658 of 11K

84540

HCPCS Procedure Code

HCPCS code 84540 is the #4,658 most-billed Medicaid procedure code, with $464K in payments across 244K claims from 2018–2024. The national median cost per claim is $1.46. Costs vary widely — the 90th percentile is $3.76 per claim, 2.6× the median.

Total Paid

$464K

0.00% of all spending

Total Claims

244K

Providers

151

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for 84540? Based on 111 providers billing this code nationally.

Median

$1.46

Average

$1.85

Std Dev

$1.76

Max

$7.92

Percentile Distribution (Cost per Claim)

p10

$0.19

p25

$0.54

Median

$1.46

p75

$2.83

p90

$3.76

p95

$5.42

p99

$7.67

50% of providers bill between $0.54 and $2.83 per claim for this code.

90% bill between $0.19 and $3.76.

Top 1% bill above $7.67.

About This Procedure

HCPCS code 84540 was billed by 151 providers across 244K claims, totaling $464K in Medicaid payments from 2018–2024. This code was used for 182K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$1.46

Providers Billing

111

National Spending

$464K

Avg/Median Ratio

1.27×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 84540

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1699849786	$225K	$2.67	1.8× median	Above Median
2	1083698534	$53K	$2.26	1.5× median	Above Median
3	1245720820	$50K	$3.15	2.2× median	Above 75th
4	1982606992	$20K	$3.00	2.1× median	Above 75th
5	1124024922	$15K	$3.20	2.2× median	Above 75th
6	Quest Diagnostics Incorporated Clifton, NJ · Clinical Medical Laboratory	$9K	$2.65	1.8× median	Above Median
7	1255335535	$8K	$3.18	2.2× median	Above 75th
8	1003810375	$7K	$3.51	2.4× median	Above 75th
9	1396321022	$7K	$3.44	2.4× median	Above 75th
10	1053334755	$7K	$1.78	1.2× median	Above Median
11	Bronxcare Health System Bronx, NY · General Acute Care Hospital	$7K	$3.18	2.2× median	Above 75th
12	Bioreference Health Llc Elmwood Park, NJ · Clinical Medical Laboratory	$6K	$2.94	2.0× median	Above 75th
13	1235234402	$5K	$2.67	1.8× median	Above Median
14	1972582062	$5K	$1.76	1.2× median	Above Median
15	1457354656	$4K	$2.27	1.6× median	Above Median
16	1114902814	$3K	$1.86	1.3× median	Above Median
17	1104829159	$3K	$3.01	2.1× median	Above 75th
18	Lenco Diagnostic Laboratories,inc. Brooklyn, NY · Clinical Medical Laboratory	$3K	$4.73	3.2× median	Top 10%
19	Dallas County Hospital District Dallas, TX · Clinic/Center, Ambulatory Surgical	$2K	$4.76	3.3× median	Top 10%
20	1396287082	$2K	$5.12	3.5× median	Top 10%

Showing top 20 of 151 providers billing this code

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