0259
HCPCS Procedure Code
HCPCS code 0259 is the #3,421 most-billed Medicaid procedure code, with $1.7M in payments across 217K claims from 2018–2024. The national median cost per claim is $4.32. Costs vary widely — the 90th percentile is $15.65 per claim, 3.6× the median.
Total Paid
$1.7M
0.00% of all spending
Total Claims
217K
Providers
60
Avg Cost/Claim
$8
National Cost Distribution
How much do providers bill per claim for 0259? Based on 54 providers billing this code nationally.
Median
$4.32
Average
$7.25
Std Dev
$8.95
Max
$42.53
Percentile Distribution (Cost per Claim)
50% of providers bill between $1.78 and $9.62 per claim for this code.
90% bill between $0.35 and $15.65.
Top 1% bill above $39.26.
About This Procedure
HCPCS code 0259 was billed by 60 providers across 217K claims, totaling $1.7M in Medicaid payments from 2018–2024. This code was used for 155K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$4.32
Providers Billing
54
National Spending
$1.7M
Avg/Median Ratio
1.68×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for 0259
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1073519443 | $820K |
| 2 | 1194711952 | $118K |
| 3 | 1508859323 | $103K |
| 4 | 1215927470 | $90K |
| 5 | Childrens Hospital Of Los Angeles Los Angeles, CA · Case Manager/Care Coordinator | $84K |
| 6 | 1396087672 | $80K |
| 7 | 1407828429 | $48K |
| 8 | 1659359446 | $47K |
| 9 | 1437122769 | $42K |
| 10 | 1538141627 | $42K |
| 11 | 1750365375 | $41K |
| 12 | 1184628919 | $35K |
| 13 | 1831188275 | $32K |
| 14 | 1962444059 | $21K |
| 15 | 1245371343 | $18K |
| 16 | Antelope Valley Health Care District Lancaster, CA · General Acute Care Hospital | $11K |
| 17 | 1467459776 | $10K |
| 18 | 1841277704 | $8K |
| 19 | 1215903018 | $8K |
| 20 | 1548328750 | $7K |
Showing top 20 of 60 providers billing this code