#3792 of 11K

95861

HCPCS Procedure Code

HCPCS code 95861 is the #3,792 most-billed Medicaid procedure code, with $1.2M in payments across 30K claims from 2018–2024. The national median cost per claim is $47.04. Costs vary widely — the 90th percentile is $119.49 per claim, 2.5× the median.

Total Paid

$1.2M

0.00% of all spending

Total Claims

30K

Providers

Avg Cost/Claim

$39

National Cost Distribution

How much do providers bill per claim for 95861? Based on 66 providers billing this code nationally.

Median

$47.04

Average

$66.03

Std Dev

$53.13

Max

$309.97

Percentile Distribution (Cost per Claim)

p10

$24.70

p25

$33.58

Median

$47.04

p75

$85.51

p90

$119.49

p95

$174.95

p99

$249.76

50% of providers bill between $33.58 and $85.51 per claim for this code.

90% bill between $24.70 and $119.49.

Top 1% bill above $249.76.

About This Procedure

HCPCS code 95861 was billed by 69 providers across 30K claims, totaling $1.2M in Medicaid payments from 2018–2024. This code was used for 26K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$47.04

Providers Billing

National Spending

$1.2M

Avg/Median Ratio

1.40×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 95861

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1740391283	$288K	$33.47	0.7× median	Below Median
2	1134307531	$140K	$36.04	0.8× median	Below Median
3	1659640381	$102K	$34.03	0.7× median	Below Median
4	1790083723	$91K	$49.71	1.1× median	Above Median
5	1659994739	$75K	$164.96	3.5× median	Top 10%
6	1124253075	$67K	$22.98	0.5× median	Below Median
7	1144210345	$59K	$117.78	2.5× median	Above 75th
8	1174916522	$44K	$21.10	0.4× median	Below Median
9	1528242906	$41K	$109.13	2.3× median	Above 75th
10	1649372673	$26K	$62.77	1.3× median	Above Median
11	1194925206	$19K	$31.66	0.7× median	Below Median
12	1508231267	$16K	$33.93	0.7× median	Below Median
13	1598066730	$15K	$31.80	0.7× median	Below Median
14	1376642900	$13K	$26.72	0.6× median	Below Median
15	1598030181	$11K	$21.04	0.4× median	Below Median
16	1275739351	$11K	$96.34	2.0× median	Above 75th
17	1790771889	$10K	$118.79	2.5× median	Above 75th
18	1659765204	$9K	$39.84	0.8× median	Below Median
19	1336492800	$9K	$35.14	0.7× median	Below Median
20	1942433834	$8K	$90.61	1.9× median	Above 75th

Showing top 20 of 69 providers billing this code

Related Procedures

95870$181K 95851$161K 95864$45K 95860$25K 95868$10K

← All procedures Top providers →