#3814 of 11K

E1225

HCPCS Procedure Code

HCPCS code E1225 is the #3,814 most-billed Medicaid procedure code, with $1.1M in payments across 11K claims from 2018–2024. The national median cost per claim is $47.32. Costs vary widely — the 90th percentile is $298.26 per claim, 6.3× the median.

Total Paid

$1.1M

0.00% of all spending

Total Claims

11K

Providers

Avg Cost/Claim

$103

National Cost Distribution

How much do providers bill per claim for E1225? Based on 26 providers billing this code nationally.

Median

$47.32

Average

$107.51

Std Dev

$121.58

Max

$424.48

Percentile Distribution (Cost per Claim)

p10

$8.78

p25

$20.73

Median

$47.32

p75

$152.94

p90

$298.26

p95

$366.97

p99

$412.63

50% of providers bill between $20.73 and $152.94 per claim for this code.

90% bill between $8.78 and $298.26.

Top 1% bill above $412.63.

About This Procedure

HCPCS code E1225 was billed by 26 providers across 11K claims, totaling $1.1M in Medicaid payments from 2018–2024. This code was used for 10K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$47.32

Providers Billing

National Spending

$1.1M

Avg/Median Ratio

2.27×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for E1225

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1518037787	$587K	$336.65	7.1× median	Top 10%
2	1982949459	$167K	$166.85	3.5× median	Above 75th
3	1639296817	$141K	$146.34	3.1× median	Above Median
4	1003889684	$64K	$143.72	3.0× median	Above Median
5	1528037538	$29K	$25.36	0.5× median	Below Median
6	1013998368	$16K	$424.48	9.0× median	Top 1%
7	1841263621	$15K	$40.72	0.9× median	Below Median
8	1114966181	$15K	$103.22	2.2× median	Above Median
9	1437165917	$14K	$181.54	3.8× median	Above 75th
10	Home Medical Equipment Specialists Llc Albuquerque, NM · Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies	$14K	$53.92	1.1× median	Above Median
11	1386800423	$11K	$26.09	0.6× median	Below Median
12	1285772343	$11K	$14.73	0.3× median	Below Median
13	1730182023	$9K	$7.31	0.2× median	Below Median
14	1871710715	$9K	$259.87	5.5× median	Above 75th
15	1427153626	$9K	$7.98	0.2× median	Below Median
16	1184883472	$6K	$377.08	8.0× median	Top 10%
17	1487239562	$5K	$9.83	0.2× median	Below Median
18	1992759153	$4K	$7.46	0.2× median	Below Median
19	1326011263	$4K	$155.15	3.3× median	Above 75th
20	1538576509	$3K	$79.90	1.7× median	Above Median

Showing top 20 of 26 providers billing this code

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