81259
HCPCS Procedure Code
HCPCS code 81259 is the #3,773 most-billed Medicaid procedure code, with $1.2M in payments across 7K claims from 2018–2024. The national median cost per claim is $128.30. Costs vary widely — the 90th percentile is $458.84 per claim, 3.6× the median.
Total Paid
$1.2M
0.00% of all spending
Total Claims
7K
Providers
10
Avg Cost/Claim
$163
National Cost Distribution
How much do providers bill per claim for 81259? Based on 9 providers billing this code nationally.
Median
$128.30
Average
$192.93
Std Dev
$195.10
Max
$571.93
Percentile Distribution (Cost per Claim)
50% of providers bill between $41.66 and $229.12 per claim for this code.
90% bill between $8.19 and $458.84.
Top 1% bill above $560.62.
About This Procedure
HCPCS code 81259 was billed by 10 providers across 7K claims, totaling $1.2M in Medicaid payments from 2018–2024. This code was used for 6K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$128.30
Providers Billing
9
National Spending
$1.2M
Avg/Median Ratio
1.50×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for 81259
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1326484569 | $501K |
| 2 | 1063892396 | $462K |
| 3 | Speciality Screening Llc Wauwatosa, WI · Clinical Medical Laboratory | $98K |
| 4 | 1639577091 | $96K |
| 5 | Bioconfirm Laboratories Llc Doraville, GA · Clinical Medical Laboratory | $12K |
| 6 | Children's Hospital Medical Center Cincinnati, OH · Clinic/Center, Primary Care | $10K |
| 7 | 1316370950 | $9K |
| 8 | 1043271539 | $2K |
| 9 | 1811484447 | $480 |
| 10 | 1386116846 | $0 |
Showing top 10 of 10 providers billing this code