#4532 of 11K

81005

HCPCS Procedure Code

HCPCS code 81005 is the #4,532 most-billed Medicaid procedure code, with $528K in payments across 486K claims from 2018–2024. The national median cost per claim is $1.10. Costs vary widely — the 90th percentile is $2.23 per claim, 2.0× the median.

Total Paid

$528K

0.00% of all spending

Total Claims

486K

Providers

434

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for 81005? Based on 342 providers billing this code nationally.

Median

$1.10

Average

$1.68

Std Dev

$5.56

Max

$97.47

Percentile Distribution (Cost per Claim)

p10

$0.09

p25

$0.38

Median

$1.10

p75

$1.75

p90

$2.23

p95

$2.83

p99

$14.70

50% of providers bill between $0.38 and $1.75 per claim for this code.

90% bill between $0.09 and $2.23.

Top 1% bill above $14.70.

About This Procedure

HCPCS code 81005 was billed by 434 providers across 486K claims, totaling $528K in Medicaid payments from 2018–2024. This code was used for 400K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$1.10

Providers Billing

342

National Spending

$528K

Avg/Median Ratio

1.53×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for 81005

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1881801835	$59K	$2.74	2.5× median	Top 10%
2	1326061730	$41K	$2.21	2.0× median	Above 75th
3	1023636545	$28K	$2.35	2.1× median	Top 10%
4	Sun River Health Inc. Peekskill, NY · Clinic/Center Federally Qualified Health Center (FQHC)	$26K	$1.79	1.6× median	Above 75th
5	1568768042	$22K	$1.93	1.8× median	Above 75th
6	1689009854	$16K	$1.71	1.6× median	Above Median
7	San Juan Regional Medical Center, Inc. Farmington, NM · Audiologist	$16K	$2.24	2.0× median	Top 10%
8	1699780536	$14K	$4.25	3.9× median	Top 10%
9	1245777358	$14K	$0.58	0.5× median	Below Median
10	1376949503	$11K	$0.86	0.8× median	Below Median
11	1396201570	$10K	$5.95	5.4× median	Top 10%
12	1699962688	$10K	$1.84	1.7× median	Above 75th
13	1023178936	$9K	$2.16	2.0× median	Above 75th
14	1366431702	$9K	$6.37	5.8× median	Top 10%
15	1447459805	$7K	$0.21	0.2× median	Below Median
16	Accu Reference Medical Lab, Llc Linden, NJ · Clinical Medical Laboratory	$7K	$1.15	1.0× median	Above Median
17	1396760542	$7K	$1.39	1.3× median	Above Median
18	1063412005	$7K	$1.67	1.5× median	Above Median
19	1477796464	$7K	$17.81	16.2× median	Top 1%
20	1336201482	$7K	$1.69	1.5× median	Above Median

Showing top 20 of 434 providers billing this code

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