#1814 of 11K

A4238

HCPCS Procedure Code

HCPCS code A4238 is the #1,814 most-billed Medicaid procedure code, with $13.4M in payments across 79K claims from 2018–2024. The national median cost per claim is $143.28.

Total Paid

$13.4M

0.00% of all spending

Total Claims

79K

Providers

Avg Cost/Claim

$169

National Cost Distribution

How much do providers bill per claim for A4238? Based on 36 providers billing this code nationally.

Median

$143.28

Average

$167.76

Std Dev

$107.13

Max

$471.04

Percentile Distribution (Cost per Claim)

p10

$48.04

p25

$90.76

Median

$143.28

p75

$219.58

p90

$261.07

p95

$359.42

p99

$469.22

50% of providers bill between $90.76 and $219.58 per claim for this code.

90% bill between $48.04 and $261.07.

Top 1% bill above $469.22.

About This Procedure

HCPCS code A4238 was billed by 38 providers across 79K claims, totaling $13.4M in Medicaid payments from 2018–2024. This code was used for 71K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$143.28

Providers Billing

National Spending

$13.4M

Avg/Median Ratio

1.17×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for A4238

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Minimed Distribution Corp. Northridge, CA · Durable Medical Equipment & Medical Supplies	$4.9M	$210.08	1.5× median	Above Median
2	1841558160	$2.1M	$219.19	1.5× median	Above Median
3	Degc Enterprises (U.s.), Inc. Clearwater, FL · Durable Medical Equipment & Medical Supplies	$1.3M	$95.41	0.7× median	Below Median
4	1174504765	$1.3M	$247.38	1.7× median	Above 75th
5	Edwards Health Care Services, Inc. Hudson, OH · Durable Medical Equipment & Medical Supplies	$663K	$147.02	1.0× median	Above Median
6	1376797704	$471K	$221.87	1.5× median	Above 75th
7	Rgh Enterprises, Llc Twinsburg, OH · Prosthetic/Orthotic Supplier	$382K	$208.83	1.5× median	Above Median
8	1316903545	$238K	$465.85	3.3× median	Top 10%
9	Integra Partners Llc Troy, MI · Orthotic Fitter	$212K	$92.27	0.6× median	Below Median
10	1871166389	$206K	$260.42	1.8× median	Above 75th
11	1801926019	$174K	$74.42	0.5× median	Below Median
12	J&b Medical Supply Co Inc Wixom, MI · Durable Medical Equipment & Medical Supplies	$156K	$188.15	1.3× median	Above Median
13	1346332863	$153K	$261.50	1.8× median	Top 10%
14	1730159617	$152K	$220.72	1.5× median	Above 75th
15	Edwards Health Care Services Inc. Morehead City, NC · Durable Medical Equipment & Medical Supplies	$148K	$167.98	1.2× median	Above Median
16	1831418672	$102K	$118.38	0.8× median	Below Median
17	1710079223	$97K	$86.24	0.6× median	Below Median
18	1033142948	$92K	$95.19	0.7× median	Below Median
19	1689980948	$92K	$126.40	0.9× median	Below Median
20	1346254620	$76K	$215.17	1.5× median	Above Median

Showing top 20 of 38 providers billing this code

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