#3875 of 11K

A4258

HCPCS Procedure Code

HCPCS code A4258 is the #3,875 most-billed Medicaid procedure code, with $1.1M in payments across 580K claims from 2018–2024. The national median cost per claim is $1.39. Costs vary widely — the 90th percentile is $11.75 per claim, 8.5× the median.

Total Paid

$1.1M

0.00% of all spending

Total Claims

580K

Providers

134

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for A4258? Based on 127 providers billing this code nationally.

Median

$1.39

Average

$3.72

Std Dev

$4.64

Max

$18.60

Percentile Distribution (Cost per Claim)

p10

$0.15

p25

$0.43

Median

$1.39

p75

$5.66

p90

$11.75

p95

$13.20

p99

$17.61

50% of providers bill between $0.43 and $5.66 per claim for this code.

90% bill between $0.15 and $11.75.

Top 1% bill above $17.61.

About This Procedure

HCPCS code A4258 was billed by 134 providers across 580K claims, totaling $1.1M in Medicaid payments from 2018–2024. This code was used for 478K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$1.39

Providers Billing

127

National Spending

$1.1M

Avg/Median Ratio

2.68×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for A4258

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1851489702	$439K	$13.45	9.7× median	Top 10%
2	1194880526	$139K	$11.41	8.2× median	Above 75th
3	1700889227	$134K	$0.54	0.4× median	Below Median
4	1104800440	$40K	$5.83	4.2× median	Above 75th
5	1972526861	$32K	$13.28	9.6× median	Top 10%
6	1376648501	$30K	$0.31	0.2× median	Below Median
7	1912145541	$28K	$11.56	8.3× median	Above 75th
8	1457884678	$23K	$8.22	5.9× median	Above 75th
9	1144244450	$22K	$12.35	8.9× median	Top 10%
10	1013086594	$21K	$11.59	8.3× median	Above 75th
11	1881900306	$20K	$0.73	0.5× median	Below Median
12	1245259282	$15K	$1.89	1.4× median	Above Median
13	Home Care Delivered, Inc. Richmond, VA · Durable Medical Equipment & Medical Supplies	$15K	$3.07	2.2× median	Above Median
14	1437385069	$12K	$0.66	0.5× median	Below Median
15	1659458073	$9K	$7.16	5.2× median	Above 75th
16	1972744431	$8K	$0.41	0.3× median	Below Median
17	Binson's Hospital Supplies, Inc. Center Line, MI · Durable Medical Equipment & Medical Supplies, Customized Equipment	$6K	$0.49	0.4× median	Below Median
18	1619925633	$6K	$3.97	2.9× median	Above Median
19	Degc Enterprises (U.s.), Inc. Clearwater, FL · Durable Medical Equipment & Medical Supplies	$5K	$6.32	4.5× median	Above 75th
20	Rgh Enterprises, Llc Twinsburg, OH · Prosthetic/Orthotic Supplier	$5K	$7.21	5.2× median	Above 75th

Showing top 20 of 134 providers billing this code

Related Procedures

A4253Blood glucose test strips$164.0M A4267$23.9M A4259Lancets for blood glucose testing$19.4M A4250$5.2M A4256$2.8M

← All procedures Top providers →