#3789 of 11K

85013

HCPCS Procedure Code

HCPCS code 85013 is the #3,789 most-billed Medicaid procedure code, with $1.2M in payments across 364K claims from 2018–2024. The national median cost per claim is $2.44. Costs vary widely — the 90th percentile is $5.94 per claim, 2.4× the median.

Total Paid

$1.2M

0.00% of all spending

Total Claims

364K

Providers

249

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for 85013? Based on 212 providers billing this code nationally.

Median

$2.44

Average

$2.88

Std Dev

$2.14

Max

$12.57

Percentile Distribution (Cost per Claim)

p10

$0.14

p25

$1.54

Median

$2.44

p75

$4.06

p90

$5.94

p95

$6.26

p99

$9.37

50% of providers bill between $1.54 and $4.06 per claim for this code.

90% bill between $0.14 and $5.94.

Top 1% bill above $9.37.

About This Procedure

HCPCS code 85013 was billed by 249 providers across 364K claims, totaling $1.2M in Medicaid payments from 2018–2024. This code was used for 340K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$2.44

Providers Billing

212

National Spending

$1.2M

Avg/Median Ratio

1.18×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 85013

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Dallas County Hospital District Dallas, TX · Clinic/Center, Ambulatory Surgical	$289K	$7.79	3.2× median	Top 10%
2	1710067020	$170K	$4.94	2.0× median	Above 75th
3	The General Hospital Corporation Boston, MA · General Acute Care Hospital	$50K	$3.97	1.6× median	Above Median
4	1801851431	$46K	$2.86	1.2× median	Above Median
5	1881758902	$40K	$6.52	2.7× median	Top 10%
6	1639257215	$32K	$2.04	0.8× median	Below Median
7	1811528656	$30K	$6.56	2.7× median	Top 10%
8	1912133364	$27K	$3.47	1.4× median	Above Median
9	1255469110	$26K	$2.84	1.2× median	Above Median
10	1992765283	$22K	$3.32	1.4× median	Above Median
11	1417910886	$22K	$2.05	0.8× median	Below Median
12	1538135249	$22K	$4.56	1.9× median	Above 75th
13	1073775987	$18K	$2.08	0.9× median	Below Median
14	1912928169	$16K	$2.07	0.8× median	Below Median
15	1679793277	$15K	$6.15	2.5× median	Top 10%
16	1346226180	$15K	$4.20	1.7× median	Above 75th
17	1619929502	$12K	$3.81	1.6× median	Above Median
18	1154431351	$12K	$5.35	2.2× median	Above 75th
19	1730472069	$12K	$2.71	1.1× median	Above Median
20	1932287182	$10K	$2.59	1.1× median	Above Median

Showing top 20 of 249 providers billing this code

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85018$109.9M 85007$11.2M 85014$10.1M 85004$912K 85008$164K

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