#2874 of 11K

A6531

HCPCS Procedure Code

HCPCS code A6531 is the #2,874 most-billed Medicaid procedure code, with $3.2M in payments across 39K claims from 2018–2024. The national median cost per claim is $43.96. Costs vary widely — the 90th percentile is $105.64 per claim, 2.4× the median.

Total Paid

$3.2M

0.00% of all spending

Total Claims

39K

Providers

Avg Cost/Claim

$83

National Cost Distribution

How much do providers bill per claim for A6531? Based on 43 providers billing this code nationally.

Median

$43.96

Average

$56.95

Std Dev

$55.55

Max

$269.51

Percentile Distribution (Cost per Claim)

p10

$10.59

p25

$22.16

Median

$43.96

p75

$69.88

p90

$105.64

p95

$157.42

p99

$258.86

50% of providers bill between $22.16 and $69.88 per claim for this code.

90% bill between $10.59 and $105.64.

Top 1% bill above $258.86.

About This Procedure

HCPCS code A6531 was billed by 43 providers across 39K claims, totaling $3.2M in Medicaid payments from 2018–2024. This code was used for 24K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$43.96

Providers Billing

National Spending

$3.2M

Avg/Median Ratio

1.30×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for A6531

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1710455027	$2.0M	$244.16	5.6× median	Top 10%
2	1164472411	$596K	$68.75	1.6× median	Above Median
3	1295862019	$103K	$43.45	1.0× median	Below Median
4	1770096372	$99K	$55.91	1.3× median	Above Median
5	1548367063	$62K	$20.42	0.5× median	Below Median
6	1396821583	$52K	$61.51	1.4× median	Above Median
7	1124783980	$44K	$91.25	2.1× median	Above 75th
8	1598714115	$34K	$18.70	0.4× median	Below Median
9	1427058650	$31K	$28.27	0.6× median	Below Median
10	1487275012	$31K	$8.62	0.2× median	Below Median
11	1518007913	$28K	$25.46	0.6× median	Below Median
12	Rgh Enterprises, Llc Twinsburg, OH · Prosthetic/Orthotic Supplier	$20K	$58.58	1.3× median	Above Median
13	1851474506	$17K	$115.97	2.6× median	Top 10%
14	1649283300	$15K	$14.74	0.3× median	Below Median
15	1255741765	$15K	$109.24	2.5× median	Top 10%
16	1841291200	$14K	$39.74	0.9× median	Below Median
17	1699752923	$13K	$269.51	6.1× median	Top 1%
18	1770127540	$12K	$10.23	0.2× median	Below Median
19	1124425871	$10K	$71.02	1.6× median	Above 75th
20	Byram Healthcare Centers, Inc. Downers Grove, IL · Durable Medical Equipment & Medical Supplies	$9K	$32.26	0.7× median	Below Median

Showing top 20 of 43 providers billing this code

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A6530$46.4M A6539$13.6M A6533$9.5M A6540$4.6M A6534$365K

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