#2858 of 11K

V5260

HCPCS Procedure Code

HCPCS code V5260 is the #2,858 most-billed Medicaid procedure code, with $3.3M in payments across 2,833 claims from 2018–2024. The national median cost per claim is $752.00. Costs vary widely — the 90th percentile is $2,657.45 per claim, 3.5× the median.

Total Paid

$3.3M

0.00% of all spending

Total Claims

2,833

Providers

Avg Cost/Claim

$1K

National Cost Distribution

How much do providers bill per claim for V5260? Based on 27 providers billing this code nationally.

Median

$752.00

Average

$1,223.57

Std Dev

$1,193.81

Max

$5,258.11

Percentile Distribution (Cost per Claim)

p10

$499.25

p25

$662.60

Median

$752.00

p75

$1,104.38

p90

$2,657.45

p95

$3,986.34

p99

$5,004.19

50% of providers bill between $662.60 and $1,104.38 per claim for this code.

90% bill between $499.25 and $2,657.45.

Top 1% bill above $5,004.19.

About This Procedure

HCPCS code V5260 was billed by 28 providers across 2,833 claims, totaling $3.3M in Medicaid payments from 2018–2024. This code was used for 2,547 unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$752.00

Providers Billing

National Spending

$3.3M

Avg/Median Ratio

1.63×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for V5260

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1164707998	$1.0M	$1,105.85	1.5× median	Above 75th
2	1205958691	$552K	$5,258.11	7.0× median	Top 1%
3	1720151145	$524K	$3,297.63	4.4× median	Top 10%
4	1659521391	$222K	$470.70	0.6× median	Below Median
5	1033585302	$151K	$1,442.23	1.9× median	Above 75th
6	1891845335	$146K	$671.77	0.9× median	Below Median
7	1689601130	$116K	$845.43	1.1× median	Above Median
8	1598891855	$77K	$959.78	1.3× median	Above Median
9	1346281151	$63K	$695.52	0.9× median	Below Median
10	1194834143	$52K	$904.82	1.2× median	Above Median
11	1720243637	$51K	$4,281.50	5.7× median	Top 10%
12	1114081338	$51K	$900.44	1.2× median	Above Median
13	1235684069	$42K	$643.70	0.9× median	Below Median
14	1134459258	$33K	$511.25	0.7× median	Below Median
15	1962649780	$27K	$2,230.67	3.0× median	Above 75th
16	1780312942	$22K	$752.00	1.0× median	Above Median
17	1316243942	$19K	$752.00	1.0× median	Above Median
18	1871798710	$18K	$1,300.00	1.7× median	Above 75th
19	1265846166	$18K	$706.88	0.9× median	Below Median
20	1417383464	$15K	$1,102.90	1.5× median	Above Median

Showing top 20 of 28 providers billing this code

Related Procedures

V5261$90.9M V5257$27.1M V5266$18.9M V5256$7.8M V5264$7.3M

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