#2109 of 11K

OP259

HCPCS Procedure Code

HCPCS code OP259 is the #2,109 most-billed Medicaid procedure code, with $8.9M in payments across 1.4M claims from 2018–2024. The national median cost per claim is $3.13. Costs vary widely — the 90th percentile is $13.24 per claim, 4.2× the median.

Total Paid

$8.9M

0.00% of all spending

Total Claims

1.4M

Providers

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for OP259? Based on 57 providers billing this code nationally.

Median

$3.13

Average

$6.32

Std Dev

$12.74

Max

$90.84

Percentile Distribution (Cost per Claim)

p10

$0.42

p25

$1.21

Median

$3.13

p75

$6.21

p90

$13.24

p95

$16.35

p99

$57.90

50% of providers bill between $1.21 and $6.21 per claim for this code.

90% bill between $0.42 and $13.24.

Top 1% bill above $57.90.

About This Procedure

HCPCS code OP259 was billed by 59 providers across 1.4M claims, totaling $8.9M in Medicaid payments from 2018–2024. This code was used for 962K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$3.13

Providers Billing

National Spending

$8.9M

Avg/Median Ratio

2.02×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for OP259

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	University Hospital Newark, NJ · General Acute Care Hospital	$2.8M	$15.66	5.0× median	Top 10%
2	1689682999	$1.1M	$90.84	29.0× median	Top 1%
3	Englewood Hospital And Medical Center Englewood, NJ · General Acute Care Hospital	$891K	$12.14	3.9× median	Above 75th
4	Virtua - West Jersey Health System Inc. Voorhees, NJ · General Acute Care Hospital	$813K	$3.53	1.1× median	Above Median
5	1134125016	$505K	$6.05	1.9× median	Above Median
6	1104859131	$413K	$6.21	2.0× median	Above Median
7	1235134024	$368K	$4.34	1.4× median	Above Median
8	The Cooper Health System Camden, NJ · General Acute Care Hospital	$275K	$3.19	1.0× median	Above Median
9	1013912633	$246K	$8.67	2.8× median	Above 75th
10	Hmh Hospitals Corporation Neptune, NJ · General Acute Care Hospital	$182K	$11.75	3.8× median	Above 75th
11	1053316844	$181K	$4.02	1.3× median	Above Median
12	1629070149	$174K	$2.17	0.7× median	Below Median
13	Inspira Medical Centers Inc. Vineland, NJ · General Acute Care Hospital	$124K	$0.98	0.3× median	Below Median
14	1013386143	$111K	$7.02	2.2× median	Above 75th
15	Trinitas Regional Medical Center Elizabeth, NJ · General Acute Care Hospital	$88K	$14.89	4.8× median	Top 10%
16	1598144362	$88K	$9.35	3.0× median	Above 75th
17	1770901761	$86K	$5.88	1.9× median	Above Median
18	1366097032	$39K	$1.21	0.4× median	Below Median
19	1922095116	$38K	$1.43	0.5× median	Below Median
20	1710491253	$31K	$1.32	0.4× median	Below Median

Showing top 20 of 59 providers billing this code

Related Procedures

OP250Orthotic or prosthetic procedure, not otherwise classified$72.5M OP258$5.0M OP251$1.7M OP252$176K OP255$111K

← All procedures Top providers →