#1235 of 11K

11981

HCPCS Procedure Code

HCPCS code 11981 is the #1,235 most-billed Medicaid procedure code, with $32.0M in payments across 188K claims from 2018–2024. The national median cost per claim is $117.16. Costs vary widely — the 90th percentile is $258.17 per claim, 2.2× the median.

Total Paid

$32.0M

0.00% of all spending

Total Claims

188K

Providers

561

Avg Cost/Claim

$170

National Cost Distribution

How much do providers bill per claim for 11981? Based on 524 providers billing this code nationally.

Median

$117.16

Average

$146.56

Std Dev

$110.88

Max

$849.53

Percentile Distribution (Cost per Claim)

p10

$37.14

p25

$70.84

Median

$117.16

p75

$212.45

p90

$258.17

p95

$301.36

p99

$598.63

50% of providers bill between $70.84 and $212.45 per claim for this code.

90% bill between $37.14 and $258.17.

Top 1% bill above $598.63.

About This Procedure

HCPCS code 11981 was billed by 561 providers across 188K claims, totaling $32.0M in Medicaid payments from 2018–2024. This code was used for 180K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$117.16

Providers Billing

524

National Spending

$32.0M

Avg/Median Ratio

1.25×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 11981

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Planned Parenthood/orange And San Bernardino Counties, Inc. Orange, CA · Clinic/Center, Ambulatory Family Planning Facility	$6.1M	$208.75	1.8× median	Above Median
2	1417959701	$2.0M	$258.74	2.2× median	Top 10%
3	1114264660	$837K	$147.81	1.3× median	Above Median
4	Boston Medical Center Corporation Boston, MA · General Acute Care Hospital	$632K	$396.50	3.4× median	Top 10%
5	1487749495	$554K	$212.35	1.8× median	Above Median
6	1497847487	$487K	$226.88	1.9× median	Above 75th
7	1306909957	$477K	$265.39	2.3× median	Top 10%
8	1285701672	$467K	$295.35	2.5× median	Top 10%
9	The New York And Presbyterian Hospital New York, NY · General Acute Care Hospital	$435K	$400.01	3.4× median	Top 10%
10	Medical Associates Of Ebnhc East Boston, MA · Clinic/Center, Community Health	$432K	$165.23	1.4× median	Above Median
11	1821095779	$431K	$133.80	1.1× median	Above Median
12	1366496838	$399K	$244.32	2.1× median	Above 75th
13	1962456558	$383K	$243.33	2.1× median	Above 75th
14	1730136680	$351K	$109.60	0.9× median	Below Median
15	1982798831	$341K	$212.10	1.8× median	Above Median
16	1336174325	$336K	$201.87	1.7× median	Above Median
17	1629057146	$314K	$102.94	0.9× median	Below Median
18	1093969115	$300K	$266.72	2.3× median	Top 10%
19	Cambridge Public Health Commission Cambridge, MA · General Acute Care Hospital	$284K	$130.82	1.1× median	Above Median
20	Rector & Visitors Of The University Of Virginia Charlottesville, VA · General Acute Care Hospital	$283K	$405.20	3.5× median	Top 10%

Showing top 20 of 561 providers billing this code

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