#1806 of 11K

A4245

HCPCS Procedure Code

HCPCS code A4245 is the #1,806 most-billed Medicaid procedure code, with $13.6M in payments across 2.0M claims from 2018–2024. The national median cost per claim is $2.33. Costs vary widely — the 90th percentile is $15.28 per claim, 6.6× the median.

Total Paid

$13.6M

0.00% of all spending

Total Claims

2.0M

Providers

429

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for A4245? Based on 402 providers billing this code nationally.

Median

$2.33

Average

$6.91

Std Dev

$15.52

Max

$221.68

Percentile Distribution (Cost per Claim)

p10

$0.84

p25

$1.55

Median

$2.33

p75

$6.19

p90

$15.28

p95

$26.17

p99

$71.30

50% of providers bill between $1.55 and $6.19 per claim for this code.

90% bill between $0.84 and $15.28.

Top 1% bill above $71.30.

About This Procedure

HCPCS code A4245 was billed by 429 providers across 2.0M claims, totaling $13.6M in Medicaid payments from 2018–2024. This code was used for 1.9M unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$2.33

Providers Billing

402

National Spending

$13.6M

Avg/Median Ratio

2.97×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for A4245

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1568465185	$1.3M	$9.46	4.1× median	Above 75th
2	1588974778	$1.1M	$12.46	5.3× median	Above 75th
3	1417267634	$858K	$25.37	10.9× median	Top 10%
4	1629213418	$749K	$5.71	2.5× median	Above Median
5	1922139104	$725K	$221.68	95.1× median	Top 1%
6	1295101533	$500K	$14.58	6.3× median	Above 75th
7	1689776551	$484K	$12.70	5.5× median	Above 75th
8	1366653545	$437K	$19.46	8.4× median	Top 10%
9	1912145541	$411K	$5.41	2.3× median	Above Median
10	1164410635	$391K	$6.42	2.8× median	Above 75th
11	1336123678	$390K	$8.51	3.7× median	Above 75th
12	1396834321	$348K	$71.42	30.7× median	Top 1%
13	1063968881	$265K	$28.10	12.1× median	Top 10%
14	1144358839	$246K	$27.56	11.8× median	Top 10%
15	1831241033	$222K	$12.07	5.2× median	Above 75th
16	1790758936	$207K	$7.80	3.3× median	Above 75th
17	1861480048	$187K	$14.47	6.2× median	Above 75th
18	1316058951	$182K	$5.42	2.3× median	Above Median
19	Medline Industries, Lp Grayslake, IL · Durable Medical Equipment & Medical Supplies	$178K	$7.59	3.3× median	Above 75th
20	Rgh Enterprises, Llc Twinsburg, OH · Prosthetic/Orthotic Supplier	$170K	$5.56	2.4× median	Above Median

Showing top 20 of 429 providers billing this code

Related Procedures

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