A6197
HCPCS Procedure Code
HCPCS code A6197 is the #794 most-billed Medicaid procedure code, with $78.7M in payments across 446K claims from 2018–2024. The national median cost per claim is $156.22. Costs vary widely — the 90th percentile is $433.73 per claim, 2.8× the median.
Total Paid
$78.7M
0.01% of all spending
Total Claims
446K
Providers
213
Avg Cost/Claim
$176
National Cost Distribution
How much do providers bill per claim for A6197? Based on 192 providers billing this code nationally.
Median
$156.22
Average
$192.63
Std Dev
$176.51
Max
$1,017.32
Percentile Distribution (Cost per Claim)
50% of providers bill between $55.81 and $294.49 per claim for this code.
90% bill between $3.81 and $433.73.
Top 1% bill above $678.26.
About This Procedure
HCPCS code A6197 was billed by 213 providers across 446K claims, totaling $78.7M in Medicaid payments from 2018–2024. This code was used for 377K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$156.22
Providers Billing
192
National Spending
$78.7M
Avg/Median Ratio
1.23×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for A6197
| # | Provider | Total Paid |
|---|---|---|
| 1 | Byram Healthcare Centers, Inc. Downers Grove, IL · Durable Medical Equipment & Medical Supplies | $9.9M |
| 2 | Byram Healthcare Centers, Inc. Torrance, CA · Durable Medical Equipment & Medical Supplies | $5.0M |
| 3 | 1548367063 | $4.2M |
| 4 | Home Care Delivered, Inc. Richmond, VA · Durable Medical Equipment & Medical Supplies | $3.8M |
| 5 | 1013124213 | $3.8M |
| 6 | Continuum, Llc Philadelphia, PA · Durable Medical Equipment & Medical Supplies | $3.5M |
| 7 | 1710932173 | $2.5M |
| 8 | 1427139641 | $2.5M |
| 9 | 1609024397 | $2.2M |
| 10 | Shield California Health Care Center Inc Valencia, CA · Durable Medical Equipment & Medical Supplies | $2.2M |
| 11 | 1649244138 | $2.1M |
| 12 | 1346295953 | $2.1M |
| 13 | Rgh Enterprises, Llc Twinsburg, OH · Prosthetic/Orthotic Supplier | $2.0M |
| 14 | 1275703084 | $1.6M |
| 15 | 1023438538 | $1.6M |
| 16 | Medline Industries, Lp Grayslake, IL · Durable Medical Equipment & Medical Supplies | $1.2M |
| 17 | 1679653356 | $1.2M |
| 18 | 1093229320 | $1.1M |
| 19 | 1730174764 | $1.1M |
| 20 | 1568083087 | $1.1M |
Showing top 20 of 213 providers billing this code