86359
HCPCS Procedure Code
HCPCS code 86359 is the #1,684 most-billed Medicaid procedure code, with $16.1M in payments across 891K claims from 2018–2024. The national median cost per claim is $19.18. Costs vary widely — the 90th percentile is $41.32 per claim, 2.2× the median.
Total Paid
$16.1M
0.00% of all spending
Total Claims
891K
Providers
432
Avg Cost/Claim
$18
National Cost Distribution
How much do providers bill per claim for 86359? Based on 419 providers billing this code nationally.
Median
$19.18
Average
$21.86
Std Dev
$18.55
Max
$171.63
Percentile Distribution (Cost per Claim)
50% of providers bill between $9.26 and $30.26 per claim for this code.
90% bill between $2.72 and $41.32.
Top 1% bill above $87.16.
About This Procedure
HCPCS code 86359 was billed by 432 providers across 891K claims, totaling $16.1M in Medicaid payments from 2018–2024. This code was used for 823K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$19.18
Providers Billing
419
National Spending
$16.1M
Avg/Median Ratio
1.14×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 86359
| # | Provider | Total Paid |
|---|---|---|
| 1 | Bioreference Health Llc Elmwood Park, NJ · Clinical Medical Laboratory | $1.5M |
| 2 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $986K |
| 3 | Laboratory Corporation Of America Holdings Burlington, NC · Clinical Medical Laboratory | $472K |
| 4 | Laboratory Corporation Of America Holdings Raritan, NJ · Clinical Medical Laboratory | $451K |
| 5 | New York City Health And Hospitals Corporation Bronx, NY · Internal Medicine | $362K |
| 6 | Laboratory Corporation Of America Tampa, FL · Clinical Medical Laboratory | $351K |
| 7 | Northwell Health Laboratories New Hyde Park, NY · Clinical Medical Laboratory | $333K |
| 8 | Quest Diagnostics Incorporated Clifton, NJ · Clinical Medical Laboratory | $319K |
| 9 | University Of Kentucky Lexington, KY · General Acute Care Hospital | $302K |
| 10 | Boston Medical Center Corporation Boston, MA · General Acute Care Hospital | $285K |
| 11 | New York City Health And Hospitals Corporation Brooklyn, NY · Internal Medicine | $251K |
| 12 | New York City Health And Hospitals Corporation Brooklyn, NY · Internal Medicine | $245K |
| 13 | New York City Health And Hospitals Corporation Bronx, NY · Internal Medicine | $231K |
| 14 | 1740265347 | $225K |
| 15 | Montefiore Medical Center Bronx, NY · Anesthesiology | $201K |
| 16 | University Of Rochester Rochester, NY · General Acute Care Hospital | $189K |
| 17 | Unilab Corporation West Hills, CA · Clinical Medical Laboratory | $178K |
| 18 | 1215930987 | $172K |
| 19 | New York City Health And Hospitals Corporation New York, NY · Internal Medicine | $167K |
| 20 | The Miriam Hospital Providence, RI · General Acute Care Hospital | $166K |
Showing top 20 of 432 providers billing this code