#1027 of 11K

K0861

HCPCS Procedure Code

HCPCS code K0861 is the #1,027 most-billed Medicaid procedure code, with $47.2M in payments across 18K claims from 2018–2024. The national median cost per claim is $2,607.07.

Total Paid

$47.2M

0.00% of all spending

Total Claims

18K

Providers

Avg Cost/Claim

$3K

National Cost Distribution

How much do providers bill per claim for K0861? Based on 72 providers billing this code nationally.

Median

$2,607.07

Average

$2,894.91

Std Dev

$1,561.38

Max

$10,239.46

Percentile Distribution (Cost per Claim)

p10

$1,397.83

p25

$2,059.04

Median

$2,607.07

p75

$3,688.70

p90

$4,187.70

p95

$4,764.99

p99

$9,188.80

50% of providers bill between $2,059.04 and $3,688.70 per claim for this code.

90% bill between $1,397.83 and $4,187.70.

Top 1% bill above $9,188.80.

About This Procedure

HCPCS code K0861 was billed by 72 providers across 18K claims, totaling $47.2M in Medicaid payments from 2018–2024. This code was used for 14K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$2,607.07

Providers Billing

National Spending

$47.2M

Avg/Median Ratio

1.11×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for K0861

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1639296817	$7.7M	$3,097.82	1.2× median	Above Median
2	1184883472	$4.4M	$4,103.43	1.6× median	Above 75th
3	1043209794	$3.2M	$3,021.58	1.2× median	Above Median
4	1790714624	$2.5M	$2,146.35	0.8× median	Below Median
5	1538576509	$2.2M	$2,455.38	0.9× median	Below Median
6	1487624193	$2.2M	$3,331.96	1.3× median	Above Median
7	1518231547	$1.9M	$2,545.04	1.0× median	Below Median
8	1215933791	$1.8M	$4,517.99	1.7× median	Top 10%
9	1114966181	$1.7M	$3,713.69	1.4× median	Above 75th
10	1568491496	$1.5M	$2,348.40	0.9× median	Below Median
11	1932484979	$1.4M	$3,219.22	1.2× median	Above Median
12	1003052598	$1.4M	$5,066.87	1.9× median	Top 10%
13	1851320774	$1.3M	$2,606.00	1.0× median	Below Median
14	1487718250	$1.1M	$2,155.76	0.8× median	Below Median
15	1891750691	$1.0M	$4,180.45	1.6× median	Above 75th
16	1124091038	$948K	$670.37	0.3× median	Below Median
17	1346588225	$895K	$2,755.32	1.1× median	Above Median
18	1003889684	$888K	$3,776.61	1.4× median	Above 75th
19	1841263621	$694K	$2,304.29	0.9× median	Below Median
20	1699845883	$536K	$2,331.60	0.9× median	Below Median

Showing top 20 of 72 providers billing this code

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