#1840 of 11K

H1003

HCPCS Procedure Code

HCPCS code H1003 is the #1,840 most-billed Medicaid procedure code, with $13.0M in payments across 1.2M claims from 2018–2024. The national median cost per claim is $10.04. Costs vary widely — the 90th percentile is $32.08 per claim, 3.2× the median.

Total Paid

$13.0M

0.00% of all spending

Total Claims

1.2M

Providers

715

Avg Cost/Claim

$11

National Cost Distribution

How much do providers bill per claim for H1003? Based on 600 providers billing this code nationally.

Median

$10.04

Average

$14.31

Std Dev

$15.93

Max

$115.61

Percentile Distribution (Cost per Claim)

p10

$0.56

p25

$3.31

Median

$10.04

p75

$18.12

p90

$32.08

p95

$45.88

p99

$77.34

50% of providers bill between $3.31 and $18.12 per claim for this code.

90% bill between $0.56 and $32.08.

Top 1% bill above $77.34.

About This Procedure

HCPCS code H1003 was billed by 715 providers across 1.2M claims, totaling $13.0M in Medicaid payments from 2018–2024. This code was used for 895K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$10.04

Providers Billing

600

National Spending

$13.0M

Avg/Median Ratio

1.43×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for H1003

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1700981487	$858K	$77.31	7.7× median	Top 10%
2	1679534069	$729K	$10.25	1.0× median	Above Median
3	1730136680	$446K	$7.57	0.8× median	Below Median
4	1891772927	$371K	$72.58	7.2× median	Top 10%
5	1851821565	$308K	$22.32	2.2× median	Above 75th
6	1487787248	$266K	$18.23	1.8× median	Above 75th
7	1699726786	$246K	$13.82	1.4× median	Above Median
8	1891971131	$224K	$27.14	2.7× median	Above 75th
9	1174741540	$221K	$80.40	8.0× median	Top 1%
10	1730169756	$218K	$18.05	1.8× median	Above Median
11	1164857512	$217K	$9.23	0.9× median	Below Median
12	1265625651	$206K	$34.83	3.5× median	Top 10%
13	1215903018	$200K	$13.19	1.3× median	Above Median
14	1386636165	$191K	$38.12	3.8× median	Top 10%
15	1962597807	$184K	$24.19	2.4× median	Above 75th
16	1245234673	$175K	$21.15	2.1× median	Above 75th
17	1144252990	$174K	$9.55	1.0× median	Below Median
18	1871967752	$167K	$9.21	0.9× median	Below Median
19	1629269618	$157K	$18.37	1.8× median	Above 75th
20	1194890558	$144K	$77.27	7.7× median	Top 10%

Showing top 20 of 715 providers billing this code

Related Procedures

H1000Prenatal care, at-risk assessment$217.0M H1001$70.5M H1010$37.8M H1002$3.7M H1005$2.6M

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