#2261 of 11K

V5264

HCPCS Procedure Code

HCPCS code V5264 is the #2,261 most-billed Medicaid procedure code, with $7.3M in payments across 153K claims from 2018–2024. The national median cost per claim is $49.58.

Total Paid

$7.3M

0.00% of all spending

Total Claims

153K

Providers

304

Avg Cost/Claim

$48

National Cost Distribution

How much do providers bill per claim for V5264? Based on 298 providers billing this code nationally.

Median

$49.58

Average

$51.28

Std Dev

$23.68

Max

$197.33

Percentile Distribution (Cost per Claim)

p10

$26.53

p25

$36.49

Median

$49.58

p75

$65.16

p90

$76.79

p95

$90.85

p99

$126.51

50% of providers bill between $36.49 and $65.16 per claim for this code.

90% bill between $26.53 and $76.79.

Top 1% bill above $126.51.

About This Procedure

HCPCS code V5264 was billed by 304 providers across 153K claims, totaling $7.3M in Medicaid payments from 2018–2024. This code was used for 128K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$49.58

Providers Billing

298

National Spending

$7.3M

Avg/Median Ratio

1.03×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for V5264

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1295967552	$406K	$73.17	1.5× median	Above 75th
2	1760783344	$328K	$39.54	0.8× median	Below Median
3	1992862312	$320K	$51.81	1.0× median	Above Median
4	1194136424	$259K	$96.93	2.0× median	Top 10%
5	Scottish Rite Children's Medical Center Atlanta, GA · Pediatrics Pediatric Hematology-Oncology	$255K	$37.59	0.8× median	Below Median
6	1750621553	$229K	$57.93	1.2× median	Above Median
7	Vhs Childrens Hospital Of Michigan Inc Detroit, MI · Clinic/Center, Ambulatory Surgical	$171K	$39.81	0.8× median	Below Median
8	1336352269	$164K	$70.62	1.4× median	Above 75th
9	1164707998	$161K	$42.62	0.9× median	Below Median
10	Upmc Children's Hospital Of Pittsburgh Pittsburgh, PA · Clinic/Center	$159K	$76.67	1.5× median	Above 75th
11	Indiana University Health, Inc Indianapolis, IN · Durable Medical Equipment & Medical Supplies	$145K	$50.66	1.0× median	Above Median
12	Children's Health System Of Texas Dallas, TX · General Acute Care Hospital Children	$135K	$120.13	2.4× median	Top 10%
13	District Medical Group, Inc Phoenix, AZ · Anesthesiology	$128K	$40.67	0.8× median	Below Median
14	1063454346	$115K	$57.77	1.2× median	Above Median
15	1205840857	$106K	$61.96	1.2× median	Above Median
16	1881748713	$106K	$46.74	0.9× median	Below Median
17	1063630804	$102K	$66.98	1.4× median	Above 75th
18	1336605757	$95K	$70.96	1.4× median	Above 75th
19	1124622675	$95K	$72.51	1.5× median	Above 75th
20	1639101751	$91K	$72.94	1.5× median	Above 75th

Showing top 20 of 304 providers billing this code

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V5261$90.9M V5257$27.1M V5266$18.9M V5256$7.8M V5265$4.4M

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