#1805 of 11K

A6539

HCPCS Procedure Code

HCPCS code A6539 is the #1,805 most-billed Medicaid procedure code, with $13.6M in payments across 92K claims from 2018–2024. The national median cost per claim is $107.32. Costs vary widely — the 90th percentile is $242.19 per claim, 2.3× the median.

Total Paid

$13.6M

0.00% of all spending

Total Claims

92K

Providers

Avg Cost/Claim

$147

National Cost Distribution

How much do providers bill per claim for A6539? Based on 64 providers billing this code nationally.

Median

$107.32

Average

$127.02

Std Dev

$68.92

Max

$361.50

Percentile Distribution (Cost per Claim)

p10

$65.32

p25

$89.82

Median

$107.32

p75

$137.36

p90

$242.19

p95

$300.71

p99

$328.83

50% of providers bill between $89.82 and $137.36 per claim for this code.

90% bill between $65.32 and $242.19.

Top 1% bill above $328.83.

About This Procedure

HCPCS code A6539 was billed by 64 providers across 92K claims, totaling $13.6M in Medicaid payments from 2018–2024. This code was used for 77K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$107.32

Providers Billing

National Spending

$13.6M

Avg/Median Ratio

1.18×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for A6539

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1235275629	$3.1M	$189.69	1.8× median	Above 75th
2	1518007913	$2.4M	$128.04	1.2× median	Above Median
3	Integra Partners Llc Troy, MI · Orthotic Fitter	$1.7M	$151.38	1.4× median	Above 75th
4	1366590812	$1.5M	$146.12	1.4× median	Above 75th
5	1962702738	$945K	$152.23	1.4× median	Above 75th
6	1588662662	$810K	$138.87	1.3× median	Above 75th
7	1245414150	$494K	$259.46	2.4× median	Top 10%
8	1639151103	$288K	$264.74	2.5× median	Top 10%
9	1538254461	$212K	$108.06	1.0× median	Above Median
10	1568851129	$192K	$309.64	2.9× median	Top 10%
11	1639243611	$188K	$278.55	2.6× median	Top 10%
12	1215096318	$161K	$64.10	0.6× median	Below Median
13	1356370555	$144K	$97.74	0.9× median	Below Median
14	1033351077	$138K	$114.06	1.1× median	Above Median
15	1891907747	$132K	$137.51	1.3× median	Above 75th
16	1669635173	$114K	$80.36	0.7× median	Below Median
17	1700155017	$94K	$118.72	1.1× median	Above Median
18	1144207911	$91K	$188.27	1.8× median	Above 75th
19	1962568832	$72K	$125.70	1.2× median	Above Median
20	1417297698	$56K	$86.45	0.8× median	Below Median

Showing top 20 of 64 providers billing this code

Related Procedures

A6530$46.4M A6549$44.6M A6533$9.5M A6540$4.6M A6545$3.8M

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