81216
HCPCS Procedure Code
HCPCS code 81216 is the #6,850 most-billed Medicaid procedure code, with $40K in payments across 4,286 claims from 2018–2024. The national median cost per claim is $12.88. Costs vary widely — the 90th percentile is $150.56 per claim, 11.7× the median.
Total Paid
$40K
0.00% of all spending
Total Claims
4,286
Providers
11
Avg Cost/Claim
$9
National Cost Distribution
How much do providers bill per claim for 81216? Based on 9 providers billing this code nationally.
Median
$12.88
Average
$44.74
Std Dev
$62.83
Max
$160.44
Percentile Distribution (Cost per Claim)
50% of providers bill between $7.61 and $30.56 per claim for this code.
90% bill between $3.62 and $150.56.
Top 1% bill above $159.45.
About This Procedure
HCPCS code 81216 was billed by 11 providers across 4,286 claims, totaling $40K in Medicaid payments from 2018–2024. This code was used for 4,072 unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$12.88
Providers Billing
9
National Spending
$40K
Avg/Median Ratio
3.47×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for 81216
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1013973866 | $14K |
| 2 | Invitae Corporation San Francisco, CA · Clinical Medical Laboratory | $13K |
| 3 | 1558067199 | $4K |
| 4 | 1447843750 | $3K |
| 5 | 1396384251 | $2K |
| 6 | Bioconfirm Laboratories Llc Doraville, GA · Clinical Medical Laboratory | $2K |
| 7 | 1760189898 | $1K |
| 8 | 1134439573 | $296 |
| 9 | 1518366426 | $167 |
| 10 | 1861157364 | $0 |
| 11 | 1588088587 | $0 |
Showing top 11 of 11 providers billing this code