#2112 of 11K

S9542

HCPCS Procedure Code

HCPCS code S9542 is the #2,112 most-billed Medicaid procedure code, with $8.8M in payments across 129K claims from 2018–2024. The national median cost per claim is $43.71. Costs vary widely — the 90th percentile is $181.09 per claim, 4.1× the median.

Total Paid

$8.8M

0.00% of all spending

Total Claims

129K

Providers

Avg Cost/Claim

$68

National Cost Distribution

How much do providers bill per claim for S9542? Based on 42 providers billing this code nationally.

Median

$43.71

Average

$120.50

Std Dev

$225.33

Max

$1,048.76

Percentile Distribution (Cost per Claim)

p10

$1.55

p25

$21.30

Median

$43.71

p75

$125.33

p90

$181.09

p95

$427.80

p99

$1,034.62

50% of providers bill between $21.30 and $125.33 per claim for this code.

90% bill between $1.55 and $181.09.

Top 1% bill above $1,034.62.

About This Procedure

HCPCS code S9542 was billed by 48 providers across 129K claims, totaling $8.8M in Medicaid payments from 2018–2024. This code was used for 62K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$43.71

Providers Billing

National Spending

$8.8M

Avg/Median Ratio

2.76×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for S9542

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1972894772	$2.2M	$430.07	9.8× median	Top 10%
2	1386892933	$1.5M	$148.93	3.4× median	Above 75th
3	1588804777	$698K	$1,048.76	24.0× median	Top 1%
4	1659550176	$685K	$384.69	8.8× median	Top 10%
5	1831241033	$613K	$151.15	3.5× median	Above 75th
6	1932266632	$608K	$72.66	1.7× median	Above Median
7	1477796464	$323K	$1,014.28	23.2× median	Top 10%
8	Optum Women's And Children's Health, Llc Marietta, GA · Home Health	$318K	$170.95	3.9× median	Above 75th
9	1972841872	$246K	$104.79	2.4× median	Above Median
10	1518036458	$219K	$25.19	0.6× median	Below Median
11	1952440604	$210K	$43.82	1.0× median	Above Median
12	1376631457	$174K	$37.11	0.8× median	Below Median
13	Optum Infusion Services 308 Llc Chandler, AZ · Pharmacy Home Infusion Therapy Pharmacy	$143K	$3.45	0.1× median	Below Median
14	1992741060	$140K	$132.18	3.0× median	Above 75th
15	1902182637	$138K	$60.93	1.4× median	Above Median
16	1417097593	$106K	$139.53	3.2× median	Above 75th
17	1356445845	$97K	$30.31	0.7× median	Below Median
18	1073054714	$56K	$74.21	1.7× median	Above Median
19	1104230176	$50K	$132.39	3.0× median	Above 75th
20	1992788350	$39K	$43.56	1.0× median	Below Median

Showing top 20 of 48 providers billing this code

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