#1414 of 11K

A6209

HCPCS Procedure Code

HCPCS code A6209 is the #1,414 most-billed Medicaid procedure code, with $23.9M in payments across 353K claims from 2018–2024. The national median cost per claim is $55.36. Costs vary widely — the 90th percentile is $164.46 per claim, 3.0× the median.

Total Paid

$23.9M

0.00% of all spending

Total Claims

353K

Providers

230

Avg Cost/Claim

$68

National Cost Distribution

How much do providers bill per claim for A6209? Based on 217 providers billing this code nationally.

Median

$55.36

Average

$71.29

Std Dev

$67.37

Max

$378.77

Percentile Distribution (Cost per Claim)

p10

$3.46

p25

$13.94

Median

$55.36

p75

$106.59

p90

$164.46

p95

$196.63

p99

$293.98

50% of providers bill between $13.94 and $106.59 per claim for this code.

90% bill between $3.46 and $164.46.

Top 1% bill above $293.98.

About This Procedure

HCPCS code A6209 was billed by 230 providers across 353K claims, totaling $23.9M in Medicaid payments from 2018–2024. This code was used for 289K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$55.36

Providers Billing

217

National Spending

$23.9M

Avg/Median Ratio

1.29×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for A6209

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1548367063	$1.6M	$45.98	0.8× median	Below Median
2	Apple Homecare Medical Supply Llc Richardson, TX · Durable Medical Equipment & Medical Supplies, Customized Equipment	$988K	$131.20	2.4× median	Above 75th
3	Pediatric Home Respiratory Services Llc Roseville, MN · Home Health	$938K	$192.35	3.5× median	Top 10%
4	Home Care Delivered, Inc. Richmond, VA · Durable Medical Equipment & Medical Supplies	$880K	$86.81	1.6× median	Above Median
5	1033289889	$769K	$307.28	5.6× median	Top 1%
6	1649244138	$763K	$85.54	1.5× median	Above Median
7	1013124213	$761K	$18.12	0.3× median	Below Median
8	Shield California Health Care Center Inc Valencia, CA · Durable Medical Equipment & Medical Supplies	$700K	$84.15	1.5× median	Above Median
9	1013952613	$693K	$139.72	2.5× median	Above 75th
10	Byram Healthcare Centers, Inc. Downers Grove, IL · Durable Medical Equipment & Medical Supplies	$645K	$52.79	1.0× median	Below Median
11	1083615991	$568K	$129.15	2.3× median	Above 75th
12	1477748119	$554K	$149.47	2.7× median	Above 75th
13	1861480048	$542K	$205.66	3.7× median	Top 10%
14	1750608147	$541K	$150.69	2.7× median	Above 75th
15	1407159817	$535K	$162.07	2.9× median	Above 75th
16	Rgh Enterprises, Llc Twinsburg, OH · Prosthetic/Orthotic Supplier	$489K	$83.54	1.5× median	Above Median
17	Byram Healthcare Centers, Inc. Torrance, CA · Durable Medical Equipment & Medical Supplies	$466K	$81.79	1.5× median	Above Median
18	1801866173	$418K	$102.27	1.8× median	Above Median
19	The Promptcare Companies, Inc. King Of Prussia, PA · Durable Medical Equipment & Medical Supplies	$410K	$112.65	2.0× median	Above 75th
20	1609024397	$396K	$152.34	2.8× median	Above 75th

Showing top 20 of 230 providers billing this code

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A6212$60.0M A6210$34.5M A6211$14.6M A6213$13.1M A6216Gauze, non-impregnated, sterile$7.1M

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