94642
HCPCS Procedure Code
HCPCS code 94642 is the #3,458 most-billed Medicaid procedure code, with $1.7M in payments across 22K claims from 2018–2024. The national median cost per claim is $45.48. Costs vary widely — the 90th percentile is $143.25 per claim, 3.1× the median.
Total Paid
$1.7M
0.00% of all spending
Total Claims
22K
Providers
41
Avg Cost/Claim
$76
National Cost Distribution
How much do providers bill per claim for 94642? Based on 36 providers billing this code nationally.
Median
$45.48
Average
$61.32
Std Dev
$58.63
Max
$230.59
Percentile Distribution (Cost per Claim)
50% of providers bill between $15.96 and $84.98 per claim for this code.
90% bill between $1.99 and $143.25.
Top 1% bill above $215.65.
About This Procedure
HCPCS code 94642 was billed by 41 providers across 22K claims, totaling $1.7M in Medicaid payments from 2018–2024. This code was used for 20K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$45.48
Providers Billing
36
National Spending
$1.7M
Avg/Median Ratio
1.35×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 94642
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1063412005 | $413K |
| 2 | 1891059127 | $389K |
| 3 | Childrens Hospital Of Los Angeles Los Angeles, CA · Case Manager/Care Coordinator | $217K |
| 4 | 1124288931 | $132K |
| 5 | Scottish Rite Children's Medical Center Atlanta, GA · Pediatrics Pediatric Hematology-Oncology | $78K |
| 6 | The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital | $78K |
| 7 | 1417957473 | $58K |
| 8 | 1194016923 | $52K |
| 9 | Egleston Children's Hospital At Emory University Inc. Atlanta, GA · Pediatrics Pediatric Emergency Medicine | $52K |
| 10 | Children's Hospital Of Wisconsin, Inc. Milwaukee, WI · Dentist, Pediatric Dentistry | $46K |
| 11 | 1225033814 | $37K |
| 12 | 1083759641 | $21K |
| 13 | 1114531035 | $17K |
| 14 | State Of Mississippi - University Of Mississippi Medical Center Jackson, MS · General Acute Care Hospital | $10K |
| 15 | Virginia Commonwealth University Health System Authority Richmond, VA · General Acute Care Hospital | $10K |
| 16 | Kennedy University Hospital Inc. Stratford, NJ · General Acute Care Hospital | $9K |
| 17 | 1902988942 | $6K |
| 18 | 1326447939 | $6K |
| 19 | Johns Hopkins All Children's Hospital Inc St Petersburg, FL · General Acute Care Hospital Children | $4K |
| 20 | Robert Wood Johnson University Hospital, Inc New Brunswick, NJ · General Acute Care Hospital | $3K |
Showing top 20 of 41 providers billing this code