86905
HCPCS Procedure Code
HCPCS code 86905 is the #4,465 most-billed Medicaid procedure code, with $571K in payments across 49K claims from 2018–2024. The national median cost per claim is $3.06. Costs vary widely — the 90th percentile is $61.23 per claim, 20.0× the median.
Total Paid
$571K
0.00% of all spending
Total Claims
49K
Providers
83
Avg Cost/Claim
$12
National Cost Distribution
How much do providers bill per claim for 86905? Based on 76 providers billing this code nationally.
Median
$3.06
Average
$19.52
Std Dev
$43.45
Max
$315.58
Percentile Distribution (Cost per Claim)
50% of providers bill between $1.64 and $17.37 per claim for this code.
90% bill between $0.52 and $61.23.
Top 1% bill above $172.79.
About This Procedure
HCPCS code 86905 was billed by 83 providers across 49K claims, totaling $571K in Medicaid payments from 2018–2024. This code was used for 40K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$3.06
Providers Billing
76
National Spending
$571K
Avg/Median Ratio
6.38×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for 86905
| # | Provider | Total Paid |
|---|---|---|
| 1 | The Nemours Foundation Wilmington, DE · General Acute Care Hospital Children | $128K |
| 2 | Arthur G James Cancer Hospital And Research Institute Columbus, OH · Special Hospital | $107K |
| 3 | Yale New Haven Hospital New Haven, CT · General Acute Care Hospital | $62K |
| 4 | Childrens Hospital Of Los Angeles Los Angeles, CA · Case Manager/Care Coordinator | $43K |
| 5 | 1215030697 | $36K |
| 6 | Arkansas Childrens Hospital Little Rock, AR · Clinic/Center, Critical Access Hospital | $34K |
| 7 | 1316241102 | $16K |
| 8 | Florida Clinical Practice Association Inc Gainesville, FL · Surgery | $13K |
| 9 | 1205935012 | $12K |
| 10 | Robert Wood Johnson University Hospital, Inc New Brunswick, NJ · General Acute Care Hospital | $10K |
| 11 | 1073504981 | $10K |
| 12 | Spectrum Health Hospitals Grand Rapids, MI · General Acute Care Hospital | $10K |
| 13 | Children's Hospital Corporation Boston, MA · Clinic/Center | $9K |
| 14 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $7K |
| 15 | 1164583753 | $6K |
| 16 | Mount Sinai Hospital New York, NY · Ambulance | $6K |
| 17 | Unilab Corporation West Hills, CA · Clinical Medical Laboratory | $6K |
| 18 | The Cooper Health System Camden, NJ · General Acute Care Hospital | $5K |
| 19 | University Of Kentucky Lexington, KY · General Acute Care Hospital | $5K |
| 20 | 1194740787 | $4K |
Showing top 20 of 83 providers billing this code