#2415 of 11K

87498

HCPCS Procedure Code

HCPCS code 87498 is the #2,415 most-billed Medicaid procedure code, with $6.0M in payments across 431K claims from 2018–2024. The national median cost per claim is $10.02. Costs vary widely — the 90th percentile is $26.92 per claim, 2.7× the median.

Total Paid

$6.0M

0.00% of all spending

Total Claims

431K

Providers

226

Avg Cost/Claim

$14

National Cost Distribution

How much do providers bill per claim for 87498? Based on 202 providers billing this code nationally.

Median

$10.02

Average

$11.60

Std Dev

$10.64

Max

$45.08

Percentile Distribution (Cost per Claim)

p10

$0.64

p25

$1.75

Median

$10.02

p75

$17.68

p90

$26.92

p95

$30.87

p99

$42.22

50% of providers bill between $1.75 and $17.68 per claim for this code.

90% bill between $0.64 and $26.92.

Top 1% bill above $42.22.

About This Procedure

HCPCS code 87498 was billed by 226 providers across 431K claims, totaling $6.0M in Medicaid payments from 2018–2024. This code was used for 368K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$10.02

Providers Billing

202

National Spending

$6.0M

Avg/Median Ratio

1.16×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 87498

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1598266421	$1.0M	$12.97	1.3× median	Above Median
2	1033239413	$937K	$17.44	1.7× median	Above Median
3	1053721373	$634K	$20.26	2.0× median	Above 75th
4	1407487465	$339K	$18.28	1.8× median	Above 75th
5	1942641774	$270K	$17.41	1.7× median	Above Median
6	Healthtrackrx Indiana, Inc Denton, TX · Clinical Medical Laboratory	$264K	$13.90	1.4× median	Above Median
7	1780059717	$202K	$30.77	3.1× median	Top 10%
8	Physicians Group Laboratories, Llc Houma, LA · Clinical Medical Laboratory	$192K	$27.05	2.7× median	Top 10%
9	Doctors Hospital At Renaissance, Ltd Edinburg, TX · Clinic/Center, Ambulatory Surgical	$183K	$45.08	4.5× median	Top 1%
10	1760531479	$150K	$17.09	1.7× median	Above Median
11	1457977209	$113K	$12.25	1.2× median	Above Median
12	1134142631	$99K	$24.89	2.5× median	Above 75th
13	1104137439	$78K	$21.18	2.1× median	Above 75th
14	Dx Solutions, Llc Nicholasville, KY · Clinical Medical Laboratory	$75K	$14.78	1.5× median	Above Median
15	1720409154	$66K	$6.06	0.6× median	Below Median
16	Accu Reference Medical Lab, Llc Linden, NJ · Clinical Medical Laboratory	$64K	$11.90	1.2× median	Above Median
17	Mako Medical Laboratories, Llc Raleigh, NC · Clinical Medical Laboratory	$62K	$17.54	1.8× median	Above Median
18	1093396160	$58K	$42.33	4.2× median	Top 1%
19	1164775862	$54K	$19.83	2.0× median	Above 75th
20	1316378789	$53K	$11.52	1.1× median	Above Median

Showing top 20 of 226 providers billing this code

Related Procedures

87491Chlamydia detection, nucleic acid, amplified probe$1.39B 87502Influenza virus detection, reverse transcription, amplified probe$444.3M 87507$63.3M 87497$18.4M 87506$11.4M

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