#553 of 11K

90461

Immunization admin, additional vaccine, counseling

Immunization admin, additional vaccine, counseling is the #553 most-billed Medicaid procedure code, with $148.8M in payments across 16.9M claims from 2018–2024. The national median cost per claim is $6.93. Costs vary widely — the 90th percentile is $37.61 per claim, 5.4× the median.

Total Paid

$148.8M

0.01% of all spending

Total Claims

16.9M

Providers

10K

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for 90461? Based on 7K providers billing this code nationally.

Median

$6.93

Average

$14.31

Std Dev

$16.60

Max

$206.75

Percentile Distribution (Cost per Claim)

p10

$0.27

p25

$1.77

Median

$6.93

p75

$22.19

p90

$37.61

p95

$47.52

p99

$66.10

50% of providers bill between $1.77 and $22.19 per claim for this code.

90% bill between $0.27 and $37.61.

Top 1% bill above $66.10.

About This Procedure

HCPCS code 90461 (Immunization admin, additional vaccine, counseling) was billed by 10K providers across 16.9M claims, totaling $148.8M in Medicaid payments from 2018–2024. This code was used for 14.4M unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$6.93

Providers Billing

National Spending

$148.8M

Avg/Median Ratio

2.06×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for 90461

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1588730360	$2.3M	$60.60	8.7× median	Top 10%
2	Presbyterian Healthcare Services Albuquerque, NM · Surgery	$1.8M	$42.72	6.2× median	Top 10%
3	1720017528	$1.8M	$52.01	7.5× median	Top 10%
4	1568576056	$1.5M	$43.72	6.3× median	Top 10%
5	1124053210	$1.5M	$85.53	12.3× median	Top 1%
6	1437168135	$1.2M	$37.73	5.4× median	Top 10%
7	Optum Medical Care Of New Jersey Pc Secaucus, NJ · Durable Medical Equipment & Medical Supplies	$1.2M	$22.22	3.2× median	Above 75th
8	1184016941	$1.2M	$17.00	2.5× median	Above Median
9	1144268277	$1.2M	$35.34	5.1× median	Above 75th
10	1407191216	$1.1M	$36.82	5.3× median	Above 75th
11	1578640181	$983K	$20.30	2.9× median	Above Median
12	Jamaica Hospital Richmond Hill, NY · General Acute Care Hospital	$948K	$39.09	5.6× median	Top 10%
13	1821288606	$922K	$53.82	7.8× median	Top 10%
14	Prisma Health University Medical Group Greenville, SC · Internal Medicine	$863K	$20.51	3.0× median	Above Median
15	Topcare Medical Group Inc Dallas, TX · Pediatrics	$855K	$2.80	0.4× median	Below Median
16	1205205630	$822K	$71.91	10.4× median	Top 1%
17	1366425274	$784K	$17.40	2.5× median	Above Median
18	1700898822	$738K	$37.54	5.4× median	Above 75th
19	1639164833	$733K	$31.23	4.5× median	Above 75th
20	1215079678	$726K	$54.09	7.8× median	Top 10%

Showing top 20 of 10K providers billing this code

Related Procedures

90460Immunization administration, first vaccine/toxoid, with counseling$1.32B 90471Immunization administration, 1 vaccine, percutaneous/ID/SC/IM$551.7M 90470$0

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