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#5239 of 11K

64561

HCPCS Procedure Code

HCPCS code 64561 is the #5,239 most-billed Medicaid procedure code, with $253K in payments across 417 claims from 2018–2024. The national median cost per claim is $219.75. Costs vary widely — the 90th percentile is $827.07 per claim, 3.8× the median.

Total Paid

$253K

0.00% of all spending

Total Claims

417

Providers

3

Avg Cost/Claim

$608

National Cost Distribution

How much do providers bill per claim for 64561? Based on 3 providers billing this code nationally.

Median

$219.75

Average

$451.65

Std Dev

$457.72

Max

$978.90

Percentile Distribution (Cost per Claim)

p10
$168.97
p25
$188.02
Median
$219.75
p75
$599.33
p90
$827.07
p95
$902.99
p99
$963.72

50% of providers bill between $188.02 and $599.33 per claim for this code.

90% bill between $168.97 and $827.07.

Top 1% bill above $963.72.

About This Procedure

HCPCS code 64561 was billed by 3 providers across 417 claims, totaling $253K in Medicaid payments from 2018–2024. This code was used for 230 unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$219.75

Providers Billing

3

National Spending

$253K

Avg/Median Ratio

2.06×

Highly skewed — outlier-driven

Provider Coverage

We have 3 providers billing this code in our dataset. Individual provider breakdowns are available for top-spending procedure codes.

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