#2212 of 11K

00126

HCPCS Procedure Code

HCPCS code 00126 is the #2,212 most-billed Medicaid procedure code, with $7.8M in payments across 128K claims from 2018–2024. The national median cost per claim is $58.80. Costs vary widely — the 90th percentile is $129.17 per claim, 2.2× the median.

Total Paid

$7.8M

0.00% of all spending

Total Claims

128K

Providers

437

Avg Cost/Claim

$61

National Cost Distribution

How much do providers bill per claim for 00126? Based on 410 providers billing this code nationally.

Median

$58.80

Average

$68.75

Std Dev

$42.57

Max

$233.94

Percentile Distribution (Cost per Claim)

p10

$25.52

p25

$40.83

Median

$58.80

p75

$88.04

p90

$129.17

p95

$157.20

p99

$191.22

50% of providers bill between $40.83 and $88.04 per claim for this code.

90% bill between $25.52 and $129.17.

Top 1% bill above $191.22.

About This Procedure

HCPCS code 00126 was billed by 437 providers across 128K claims, totaling $7.8M in Medicaid payments from 2018–2024. This code was used for 112K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$58.80

Providers Billing

410

National Spending

$7.8M

Avg/Median Ratio

1.17×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 00126

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1164407987	$511K	$137.08	2.3× median	Top 10%
2	The Nemours Foundation Wilmington, DE · Clinic/Center, Developmental Disabilities	$446K	$186.93	3.2× median	Top 10%
3	1205841186	$306K	$186.41	3.2× median	Top 10%
4	1497023360	$252K	$107.71	1.8× median	Above 75th
5	1467111005	$207K	$197.00	3.4× median	Top 1%
6	Ashland Hospital Corporation Ashland, KY · Clinic/Center, Rural Health	$201K	$128.14	2.2× median	Above 75th
7	1568893626	$181K	$94.92	1.6× median	Above 75th
8	1558314427	$174K	$61.63	1.0× median	Above Median
9	1194728501	$169K	$71.10	1.2× median	Above Median
10	Children's Hospital Medical Center Cincinnati, OH · Clinic/Center, Primary Care	$161K	$25.76	0.4× median	Below Median
11	Texas Children's Physician Group Houston, TX · Pediatrics	$160K	$167.40	2.8× median	Top 10%
12	1598431884	$157K	$78.78	1.3× median	Above Median
13	1225016926	$133K	$45.22	0.8× median	Below Median
14	1720087802	$129K	$81.43	1.4× median	Above Median
15	1508133497	$118K	$79.32	1.3× median	Above Median
16	1104102268	$106K	$53.97	0.9× median	Below Median
17	1629020680	$104K	$39.46	0.7× median	Below Median
18	The Nemours Foundation Orlando, FL · General Acute Care Hospital Children	$104K	$70.30	1.2× median	Above Median
19	1063939593	$104K	$74.92	1.3× median	Above Median
20	1043228448	$100K	$138.98	2.4× median	Top 10%

Showing top 20 of 437 providers billing this code

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