81238
HCPCS Procedure Code
HCPCS code 81238 is the #4,429 most-billed Medicaid procedure code, with $597K in payments across 7K claims from 2018–2024. The national median cost per claim is $40.02. Costs vary widely — the 90th percentile is $469.61 per claim, 11.7× the median.
Total Paid
$597K
0.00% of all spending
Total Claims
7K
Providers
33
Avg Cost/Claim
$89
National Cost Distribution
How much do providers bill per claim for 81238? Based on 17 providers billing this code nationally.
Median
$40.02
Average
$140.90
Std Dev
$192.98
Max
$545.45
Percentile Distribution (Cost per Claim)
50% of providers bill between $16.32 and $128.32 per claim for this code.
90% bill between $10.24 and $469.61.
Top 1% bill above $541.38.
About This Procedure
HCPCS code 81238 was billed by 33 providers across 7K claims, totaling $597K in Medicaid payments from 2018–2024. This code was used for 6K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$40.02
Providers Billing
17
National Spending
$597K
Avg/Median Ratio
3.52×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for 81238
| # | Provider | Total Paid |
|---|---|---|
| 1 | Natera Inc. San Carlos, CA · Clinical Medical Laboratory | $249K |
| 2 | 1609388842 | $140K |
| 3 | 1457977209 | $109K |
| 4 | 1447843750 | $37K |
| 5 | 1558067199 | $14K |
| 6 | 1316311863 | $12K |
| 7 | 1275292294 | $12K |
| 8 | Invitae Corporation San Francisco, CA · Clinical Medical Laboratory | $9K |
| 9 | 1760189898 | $6K |
| 10 | 1528653334 | $4K |
| 11 | 1518366426 | $1K |
| 12 | 1114539046 | $1K |
| 13 | 1689264053 | $958 |
| 14 | 1124725817 | $588 |
| 15 | 1174167597 | $408 |
| 16 | 1134439573 | $311 |
| 17 | 1215055256 | $240 |
| 18 | 1396437638 | $0 |
| 19 | 1275987034 | $0 |
| 20 | 1609449941 | $0 |
Showing top 20 of 33 providers billing this code