M0538
HCPCS Procedure Code
HCPCS code M0538 is the #6,483 most-billed Medicaid procedure code, with $62K in payments across 15K claims from 2018–2024. The national median cost per claim is $21.57. Costs vary widely — the 90th percentile is $61.46 per claim, 2.8× the median.
Total Paid
$62K
0.00% of all spending
Total Claims
15K
Providers
3
Avg Cost/Claim
$4
National Cost Distribution
How much do providers bill per claim for M0538? Based on 3 providers billing this code nationally.
Median
$21.57
Average
$31.38
Std Dev
$36.16
Max
$71.43
Percentile Distribution (Cost per Claim)
50% of providers bill between $11.36 and $46.50 per claim for this code.
90% bill between $5.23 and $61.46.
Top 1% bill above $70.43.
About This Procedure
HCPCS code M0538 was billed by 3 providers across 15K claims, totaling $62K in Medicaid payments from 2018–2024. This code was used for 2K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$21.57
Providers Billing
3
National Spending
$62K
Avg/Median Ratio
1.45×
Normal distribution
Provider Coverage
We have 3 providers billing this code in our dataset. Individual provider breakdowns are available for top-spending procedure codes.