81231
HCPCS Procedure Code
HCPCS code 81231 is the #3,951 most-billed Medicaid procedure code, with $985K in payments across 59K claims from 2018–2024. The national median cost per claim is $14.05. Costs vary widely — the 90th percentile is $95.07 per claim, 6.8× the median.
Total Paid
$985K
0.00% of all spending
Total Claims
59K
Providers
97
Avg Cost/Claim
$17
National Cost Distribution
How much do providers bill per claim for 81231? Based on 56 providers billing this code nationally.
Median
$14.05
Average
$31.82
Std Dev
$44.03
Max
$181.91
Percentile Distribution (Cost per Claim)
50% of providers bill between $5.19 and $36.39 per claim for this code.
90% bill between $1.30 and $95.07.
Top 1% bill above $171.93.
About This Procedure
HCPCS code 81231 was billed by 97 providers across 59K claims, totaling $985K in Medicaid payments from 2018–2024. This code was used for 52K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$14.05
Providers Billing
56
National Spending
$985K
Avg/Median Ratio
2.26×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for 81231
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1467850859 | $247K |
| 2 | Millennium Health Llc San Diego, CA · Clinical Medical Laboratory | $238K |
| 3 | 1821360017 | $54K |
| 4 | Gravity Diagnostics, Llc Covington, KY · Clinical Medical Laboratory | $52K |
| 5 | 1124438528 | $38K |
| 6 | Speciality Screening Llc Wauwatosa, WI · Clinical Medical Laboratory | $28K |
| 7 | 1043271539 | $28K |
| 8 | 1275971707 | $27K |
| 9 | 1760840482 | $25K |
| 10 | 1497175905 | $24K |
| 11 | 1437585262 | $20K |
| 12 | 1639541295 | $20K |
| 13 | Rca Laboratory Services, Llc Glen Allen, VA · Clinical Medical Laboratory | $18K |
| 14 | 1730628439 | $17K |
| 15 | 1669836227 | $15K |
| 16 | Empire City Laboratories, Inc Brooklyn, NY · Clinical Medical Laboratory | $14K |
| 17 | 1740733708 | $12K |
| 18 | 1720409154 | $12K |
| 19 | Crestar Labs Llc Spring Hill, TN · Clinical Medical Laboratory | $10K |
| 20 | 1790021517 | $10K |
Showing top 20 of 97 providers billing this code