#2185 of 11K

85651

HCPCS Procedure Code

HCPCS code 85651 is the #2,185 most-billed Medicaid procedure code, with $8.1M in payments across 3.4M claims from 2018–2024. The national median cost per claim is $2.42.

Total Paid

$8.1M

0.00% of all spending

Total Claims

3.4M

Providers

2,319

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for 85651? Based on 2,165 providers billing this code nationally.

Median

$2.42

Average

$3.07

Std Dev

$6.13

Max

$190.32

Percentile Distribution (Cost per Claim)

p10

$0.26

p25

$0.99

Median

$2.42

p75

$3.36

p90

$4.32

p95

$7.68

p99

$23.40

50% of providers bill between $0.99 and $3.36 per claim for this code.

90% bill between $0.26 and $4.32.

Top 1% bill above $23.40.

About This Procedure

HCPCS code 85651 was billed by 2,319 providers across 3.4M claims, totaling $8.1M in Medicaid payments from 2018–2024. This code was used for 3.1M unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$2.42

Providers Billing

2,165

National Spending

$8.1M

Avg/Median Ratio

1.27×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 85651

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Bioreference Health Llc Elmwood Park, NJ · Clinical Medical Laboratory	$423K	$1.44	0.6× median	Below Median
2	The Miriam Hospital Providence, RI · General Acute Care Hospital	$399K	$18.69	7.7× median	Top 10%
3	Rhode Island Hospital Providence, RI · General Acute Care Hospital	$370K	$25.58	10.6× median	Top 1%
4	1144202003	$335K	$3.96	1.6× median	Above 75th
5	1184606600	$133K	$11.29	4.7× median	Top 10%
6	The Nemours Foundation Wilmington, DE · General Acute Care Hospital Children	$132K	$20.03	8.3× median	Top 10%
7	1639135221	$128K	$13.79	5.7× median	Top 10%
8	1548208440	$115K	$2.90	1.2× median	Above Median
9	1700949336	$109K	$6.06	2.5× median	Top 10%
10	1134195357	$107K	$3.68	1.5× median	Above 75th
11	Accu Reference Medical Lab, Llc Linden, NJ · Clinical Medical Laboratory	$97K	$1.56	0.6× median	Below Median
12	Lenco Diagnostic Laboratories,inc. Brooklyn, NY · Clinical Medical Laboratory	$83K	$1.37	0.6× median	Below Median
13	1538570528	$77K	$4.06	1.7× median	Above 75th
14	1164402038	$76K	$3.35	1.4× median	Above Median
15	1861763658	$75K	$3.15	1.3× median	Above Median
16	1073518007	$68K	$9.05	3.7× median	Top 10%
17	Empire City Laboratories, Inc Brooklyn, NY · Clinical Medical Laboratory	$64K	$1.29	0.5× median	Below Median
18	1699704254	$62K	$11.24	4.6× median	Top 10%
19	1245275106	$61K	$1.84	0.8× median	Below Median
20	1972625499	$61K	$3.66	1.5× median	Above 75th

Showing top 20 of 2,319 providers billing this code

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