#5201 of 11K

87530

HCPCS Procedure Code

HCPCS code 87530 is the #5,201 most-billed Medicaid procedure code, with $262K in payments across 10K claims from 2018–2024. The national median cost per claim is $20.14. Costs vary widely — the 90th percentile is $47.70 per claim, 2.4× the median.

Total Paid

$262K

0.00% of all spending

Total Claims

10K

Providers

Avg Cost/Claim

$26

National Cost Distribution

How much do providers bill per claim for 87530? Based on 21 providers billing this code nationally.

Median

$20.14

Average

$26.54

Std Dev

$22.65

Max

$90.01

Percentile Distribution (Cost per Claim)

p10

$5.63

p25

$7.78

Median

$20.14

p75

$37.91

p90

$47.70

p95

$60.10

p99

$84.03

50% of providers bill between $7.78 and $37.91 per claim for this code.

90% bill between $5.63 and $47.70.

Top 1% bill above $84.03.

About This Procedure

HCPCS code 87530 was billed by 26 providers across 10K claims, totaling $262K in Medicaid payments from 2018–2024. This code was used for 8,507 unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$20.14

Providers Billing

National Spending

$262K

Avg/Median Ratio

1.32×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 87530

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1770973646	$90K	$45.37	2.3× median	Above 75th
2	Phoenix Children's Hospital Phoenix, AZ · General Acute Care Hospital Children	$39K	$90.01	4.5× median	Top 1%
3	1073023487	$25K	$10.57	0.5× median	Below Median
4	1235533779	$22K	$20.14	1.0× median	Above Median
5	1457354656	$22K	$33.88	1.7× median	Above Median
6	Montefiore Medical Center Bronx, NY · General Acute Care Hospital	$16K	$47.70	2.4× median	Top 10%
7	Quest Diagnostics Incorporated Clifton, NJ · Clinical Medical Laboratory	$15K	$37.30	1.9× median	Above Median
8	1225316482	$14K	$22.12	1.1× median	Above Median
9	1811524572	$5K	$7.78	0.4× median	Below Median
10	1275971707	$4K	$13.68	0.7× median	Below Median
11	1437119310	$2K	$6.37	0.3× median	Below Median
12	1669430773	$2K	$35.57	1.8× median	Above Median
13	Empire City Laboratories, Inc Brooklyn, NY · Clinical Medical Laboratory	$2K	$43.43	2.2× median	Above 75th
14	University Of Washington Seattle, WA · Clinical Medical Laboratory	$2K	$60.10	3.0× median	Top 10%
15	1396350187	$1K	$16.69	0.8× median	Below Median
16	1205896594	$455	$37.91	1.9× median	Above Median
17	1558808204	$379	$5.74	0.3× median	Below Median
18	Unilab Corporation West Hills, CA · Clinical Medical Laboratory	$293	$1.54	0.1× median	Below Median
19	Sherman Abrams Laboratory Inc Brooklyn, NY · Clinical Medical Laboratory	$270	$5.63	0.3× median	Below Median
20	1376944793	$201	$15.45	0.8× median	Below Median

Showing top 20 of 26 providers billing this code

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