V5261
HCPCS Procedure Code
HCPCS code V5261 is the #744 most-billed Medicaid procedure code, with $90.9M in payments across 65K claims from 2018–2024. The national median cost per claim is $848.60. Costs vary widely — the 90th percentile is $2,641.53 per claim, 3.1× the median.
Total Paid
$90.9M
0.01% of all spending
Total Claims
65K
Providers
159
Avg Cost/Claim
$1K
National Cost Distribution
How much do providers bill per claim for V5261? Based on 156 providers billing this code nationally.
Median
$848.60
Average
$1,249.61
Std Dev
$932.78
Max
$5,359.05
Percentile Distribution (Cost per Claim)
50% of providers bill between $657.57 and $1,637.56 per claim for this code.
90% bill between $521.68 and $2,641.53.
Top 1% bill above $4,114.82.
About This Procedure
HCPCS code V5261 was billed by 159 providers across 65K claims, totaling $90.9M in Medicaid payments from 2018–2024. This code was used for 59K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$848.60
Providers Billing
156
National Spending
$90.9M
Avg/Median Ratio
1.47×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for V5261
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1033585302 | $26.8M |
| 2 | 1164707998 | $13.0M |
| 3 | 1720243637 | $9.9M |
| 4 | 1356860811 | $3.6M |
| 5 | 1194136424 | $2.0M |
| 6 | 1376108712 | $1.9M |
| 7 | Scottish Rite Children's Medical Center Atlanta, GA · Pediatrics Pediatric Hematology-Oncology | $1.7M |
| 8 | 1205958691 | $1.6M |
| 9 | 1003016007 | $1.5M |
| 10 | 1376622332 | $1.4M |
| 11 | 1336605757 | $1.2M |
| 12 | 1710936836 | $1.1M |
| 13 | Medstar Washington Hospital Center Washington, DC · General Acute Care Hospital | $1.1M |
| 14 | 1326117847 | $1.0M |
| 15 | Upmc Children's Hospital Of Pittsburgh Pittsburgh, PA · Clinic/Center | $970K |
| 16 | 1639101751 | $952K |
| 17 | 1538457957 | $816K |
| 18 | 1245553643 | $813K |
| 19 | 1871798710 | $812K |
| 20 | 1114081338 | $775K |
Showing top 20 of 159 providers billing this code