#1457 of 11K

51798

HCPCS Procedure Code

HCPCS code 51798 is the #1,457 most-billed Medicaid procedure code, with $22.6M in payments across 1.9M claims from 2018–2024. The national median cost per claim is $6.59. Costs vary widely — the 90th percentile is $18.31 per claim, 2.8× the median.

Total Paid

$22.6M

0.00% of all spending

Total Claims

1.9M

Providers

2,163

Avg Cost/Claim

$12

National Cost Distribution

How much do providers bill per claim for 51798? Based on 2,068 providers billing this code nationally.

Median

$6.59

Average

$13.61

Std Dev

$39.06

Max

$764.22

Percentile Distribution (Cost per Claim)

p10

$1.56

p25

$3.78

Median

$6.59

p75

$10.75

p90

$18.31

p95

$38.57

p99

$228.33

50% of providers bill between $3.78 and $10.75 per claim for this code.

90% bill between $1.56 and $18.31.

Top 1% bill above $228.33.

About This Procedure

HCPCS code 51798 was billed by 2,163 providers across 1.9M claims, totaling $22.6M in Medicaid payments from 2018–2024. This code was used for 1.7M unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$6.59

Providers Billing

2,068

National Spending

$22.6M

Avg/Median Ratio

2.07×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for 51798

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Montefiore Medical Center Bronx, NY · General Acute Care Hospital	$1.5M	$251.60	38.2× median	Top 1%
2	1689601536	$942K	$61.19	9.3× median	Top 10%
3	1356655492	$664K	$67.65	10.3× median	Top 10%
4	Arkansas Childrens Hospital Little Rock, AR · Clinic/Center, Critical Access Hospital	$595K	$259.54	39.4× median	Top 1%
5	University Of Kentucky Lexington, KY · General Acute Care Hospital	$482K	$86.23	13.1× median	Top 10%
6	1154441343	$384K	$69.66	10.6× median	Top 10%
7	Beth Israel Medical Center Brooklyn, NY · Psychiatric Unit	$382K	$139.21	21.1× median	Top 10%
8	1548567498	$305K	$14.40	2.2× median	Above 75th
9	1336245828	$263K	$149.00	22.6× median	Top 10%
10	1457997645	$236K	$27.82	4.2× median	Top 10%
11	Maimonides Medical Center Brooklyn, NY · General Acute Care Hospital	$227K	$252.75	38.4× median	Top 1%
12	1720042336	$211K	$66.12	10.0× median	Top 10%
13	1568735660	$206K	$282.87	42.9× median	Top 1%
14	1598713745	$205K	$366.25	55.6× median	Top 1%
15	1215903018	$202K	$54.25	8.2× median	Top 10%
16	1558889956	$193K	$8.89	1.3× median	Above Median
17	1447272372	$191K	$7.35	1.1× median	Above Median
18	1518989193	$190K	$17.40	2.6× median	Above 75th
19	1881785764	$182K	$30.30	4.6× median	Top 10%
20	1669617197	$177K	$35.69	5.4× median	Top 10%

Showing top 20 of 2,163 providers billing this code

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51792$3.0M 51797$1.8M

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