81265
HCPCS Procedure Code
HCPCS code 81265 is the #6,295 most-billed Medicaid procedure code, with $77K in payments across 1,600 claims from 2018–2024. The national median cost per claim is $54.31. Costs vary widely — the 90th percentile is $218.37 per claim, 4.0× the median.
Total Paid
$77K
0.00% of all spending
Total Claims
1,600
Providers
12
Avg Cost/Claim
$48
National Cost Distribution
How much do providers bill per claim for 81265? Based on 10 providers billing this code nationally.
Median
$54.31
Average
$96.30
Std Dev
$98.77
Max
$330.34
Percentile Distribution (Cost per Claim)
50% of providers bill between $38.88 and $103.71 per claim for this code.
90% bill between $33.32 and $218.37.
Top 1% bill above $319.14.
About This Procedure
HCPCS code 81265 was billed by 12 providers across 1,600 claims, totaling $77K in Medicaid payments from 2018–2024. This code was used for 1,192 unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$54.31
Providers Billing
10
National Spending
$77K
Avg/Median Ratio
1.77×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for 81265
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1518415991 | $20K |
| 2 | Robert Wood Johnson University Hospital, Inc New Brunswick, NJ · General Acute Care Hospital | $12K |
| 3 | Children's Hospital Medical Center Cincinnati, OH · Clinic/Center, Primary Care | $10K |
| 4 | Genedx Llc Gaithersburg, MD · Medical Genetics, Ph.D. Medical Genetics | $9K |
| 5 | 1992812473 | $6K |
| 6 | 1215208236 | $5K |
| 7 | Dana-farber Cancer Institute, Inc. Boston, MA · General Acute Care Hospital | $5K |
| 8 | 1699289488 | $4K |
| 9 | 1629512140 | $3K |
| 10 | 1689975021 | $1K |
| 11 | 1124269717 | $0 |
| 12 | 1699884858 | $0 |
Showing top 12 of 12 providers billing this code