80197
HCPCS Procedure Code
HCPCS code 80197 is the #1,546 most-billed Medicaid procedure code, with $19.7M in payments across 2.4M claims from 2018–2024. The national median cost per claim is $6.57. Costs vary widely — the 90th percentile is $17.16 per claim, 2.6× the median.
Total Paid
$19.7M
0.00% of all spending
Total Claims
2.4M
Providers
543
Avg Cost/Claim
$8
National Cost Distribution
How much do providers bill per claim for 80197? Based on 522 providers billing this code nationally.
Median
$6.57
Average
$9.31
Std Dev
$12.24
Max
$145.75
Percentile Distribution (Cost per Claim)
50% of providers bill between $3.30 and $11.31 per claim for this code.
90% bill between $1.26 and $17.16.
Top 1% bill above $59.83.
About This Procedure
HCPCS code 80197 was billed by 543 providers across 2.4M claims, totaling $19.7M in Medicaid payments from 2018–2024. This code was used for 1.4M unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$6.57
Providers Billing
522
National Spending
$19.7M
Avg/Median Ratio
1.42×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 80197
| # | Provider | Total Paid |
|---|---|---|
| 1 | Unilab Corporation West Hills, CA · Clinical Medical Laboratory | $547K |
| 2 | Stanford Health Care Stanford, CA · General Acute Care Hospital | $508K |
| 3 | Laboratory Corporation Of America Holdings Burlington, NC · Clinical Medical Laboratory | $498K |
| 4 | Children's Hospital Of Wisconsin, Inc. Milwaukee, WI · Dentist, Pediatric Dentistry | $447K |
| 5 | Keck Medical Center Of Usc Los Angeles, CA · General Acute Care Hospital | $382K |
| 6 | Phoenix Children's Hospital Phoenix, AZ · General Acute Care Hospital Children | $377K |
| 7 | University Of Wisconsin Hospitals And Clinics Authority Madison, WI · General Acute Care Hospital | $370K |
| 8 | The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital | $369K |
| 9 | Virginia Commonwealth University Health System Authority Richmond, VA · General Acute Care Hospital | $334K |
| 10 | 1902803315 | $327K |
| 11 | Children's Health System Of Texas Dallas, TX · General Acute Care Hospital Children | $320K |
| 12 | City Of Hope National Medical Center Duarte, CA · General Acute Care Hospital | $304K |
| 13 | 1639172372 | $303K |
| 14 | University Of Colorado Hospital Authority Aurora, CO · General Acute Care Hospital | $297K |
| 15 | Permanente Medical Group, Inc. Richmond, CA · Clinical Medical Laboratory | $285K |
| 16 | Regents Of The University Of California San Diego, CA · General Acute Care Hospital | $281K |
| 17 | Egleston Children's Hospital At Emory University Inc. Atlanta, GA · Pediatrics Pediatric Emergency Medicine | $267K |
| 18 | Childrens Hospital Of Los Angeles Los Angeles, CA · Case Manager/Care Coordinator | $249K |
| 19 | 1891873303 | $248K |
| 20 | 1336245828 | $245K |
Showing top 20 of 543 providers billing this code