HCPCS 0004A

Other service (ClaimLight category; the code descriptor is not shown)

Other services

11,002
97th percentile among 6,326 codes billed · 2022
$19M
92nd percentile among 6,326 codes billed · 2022
484K
93rd percentile among 6,326 codes billed · 2022
19
38th percentile among 6,326 codes billed · 2022
115
58th percentile among 6,326 codes billed · 2022
-93.3%
Medicare payment on the code vs 2021; billers -67.1% · 2022

Trend

Medicare payment on the code

$0$200M2021: $286M paid20212022: $19M paid20222023: $54K paid2023$54K$0$200M2021: $286M paid20212022: $19M paid20222023: $54K paid2023$54K$0$200M2021: $286M paid20212022: $19M paid20222023: $54K paid2023$54K$0$200M2021: $286M paid20212022: $19M paid20222023: $54K paid2023$54K

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2021–2023.

Billers

020K2021: 33K providers20212022: 11K providers20222023: 27 providers202327020K2021: 33K providers20212022: 11K providers20222023: 27 providers202327020K2021: 33K providers20212022: 11K providers20222023: 27 providers202327020K2021: 33K providers20212022: 11K providers20222023: 27 providers202327

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2021–2023.

observed calculated calculated calculated calculated calculated reported
202327$53,886-100%1,254151930.00
202211,002$19,203,903-93%484,19119115
202133,439$285,625,410not in the 2020 file7,051,914100590

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2021–2023.

By state

observed calculated calculated calculated calculated calculated
Idaho47$1,700,65741,366274,959
California1,052$1,557,00536,0911991
New York601$1,223,51327,7261996
Illinois552$1,098,73427,68119120
Pennsylvania556$956,81624,35919164
Texas548$755,33019,3031797
Colorado97$733,29918,2411990
Florida655$725,50918,6711766
Massachusetts355$699,32716,01123126
North Carolina474$633,53716,97318109
Virginia370$629,21115,60219128
New Jersey394$613,46114,1692082
Maryland310$543,04212,87221166
Ohio434$488,75513,0751782
Washington236$457,35411,64519173

Not listed: 4 states with fewer than 11 billers (small cells).

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Providers placed by practice address. Data year 2022.

Top metro areas

observed calculated calculated calculated calculated
Boise City, ID14$1,654,36940,0791,396
New York-Newark-Jersey City, NY-NJ725$1,475,85832,93120
Chicago-Naperville-Elgin, IL-IN316$774,08619,09518
Denver-Aurora-Centennial, CO37$661,98116,47317
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD323$623,41215,12019
Los Angeles-Long Beach-Anaheim, CA352$532,79412,26919
Boston-Cambridge-Newton, MA-NH276$522,84412,04121
Washington-Arlington-Alexandria, DC-VA-MD-WV231$410,6289,50020
Dallas-Fort Worth-Arlington, TX195$286,1717,22816
Baltimore-Columbia-Towson, MD162$263,8296,28523
Seattle-Tacoma-Bellevue, WA130$244,8566,21816
San Francisco-Oakland-Fremont, CA148$229,6105,06317
Atlanta-Sandy Springs-Roswell, GA150$215,3605,52116
Phoenix-Mesa-Chandler, AZ173$184,9825,00720
Kansas City, MO-KS132$174,1074,64319

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). The 93 areas with the most payment among those with at least 11 billers; non-metro parts of each state are one area. Data year 2022.

Specialties billing 0004A nationally

Mass Immunizer Roster Biller accounts for 40% of payment for 0004A nationally in 2022, across 16 specialties on claims.

observed calculated calculated calculated calculated calculated
Mass Immunizer Roster Biller5,16747%$7,763,49940%195,75538
Centralized Flu2,16620%$4,241,21222%104,63448
Pharmacy5314.8%$2,042,32611%51,11096
Family Practice1,21211%$1,636,2698.5%42,48935
Internal Medicine7907.2%$1,431,1747.5%36,33446
Nurse Practitioner6676.1%$717,3143.7%18,69728
Clinical Laboratory610.55%$235,6531.2%6,227102
Emergency Medicine420.38%$183,9600.96%4,776114
Public Health or Welfare Agency400.36%$143,5310.75%3,72993
Pediatric Medicine400.36%$142,6740.74%3,73093
Infectious Disease220.20%$122,9480.64%3,032138
Physician Assistant920.84%$79,8440.42%2,05822
All Other Suppliers180.16%$47,3830.25%1,22068
General Practice220.20%$45,2570.24%1,16053
Hospitalist110.10%$31,0310.16%75969

Not listed: 34 specialties with fewer than 11 billers (small cells).

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Provider-level lines (fewer than 11 beneficiaries suppressed by CMS); specialty is the provider type on claims. Data year 2022.

Top billers of 0004A nationally

Named top billers are a Pro figure, and Pro is not available to buy, so this list is not shown to any account. The counts and totals by state, metro area and specialty on this page are free.

Original Medicare Part B fee-for-service only; CMS suppresses provider lines with fewer than 11 beneficiaries. How these figures are computed · Limitations