#1570 of 11K

V5266

HCPCS Procedure Code

HCPCS code V5266 is the #1,570 most-billed Medicaid procedure code, with $18.9M in payments across 890K claims from 2018–2024. The national median cost per claim is $15.52. Costs vary widely — the 90th percentile is $44.12 per claim, 2.8× the median.

Total Paid

$18.9M

0.00% of all spending

Total Claims

890K

Providers

691

Avg Cost/Claim

$21

National Cost Distribution

How much do providers bill per claim for V5266? Based on 678 providers billing this code nationally.

Median

$15.52

Average

$22.83

Std Dev

$30.93

Max

$579.07

Percentile Distribution (Cost per Claim)

p10

$5.59

p25

$9.42

Median

$15.52

p75

$27.60

p90

$44.12

p95

$63.22

p99

$98.32

50% of providers bill between $9.42 and $27.60 per claim for this code.

90% bill between $5.59 and $44.12.

Top 1% bill above $98.32.

About This Procedure

HCPCS code V5266 was billed by 691 providers across 890K claims, totaling $18.9M in Medicaid payments from 2018–2024. This code was used for 817K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$15.52

Providers Billing

678

National Spending

$18.9M

Avg/Median Ratio

1.47×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for V5266

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1336352269	$1.5M	$23.70	1.5× median	Above Median
2	1063630804	$1.1M	$23.30	1.5× median	Above Median
3	1033585302	$847K	$56.48	3.6× median	Top 10%
4	1194136424	$728K	$59.90	3.9× median	Top 10%
5	1124622675	$720K	$23.43	1.5× median	Above Median
6	1538457957	$657K	$31.79	2.0× median	Above 75th
7	1760661052	$567K	$21.52	1.4× median	Above Median
8	1295967552	$491K	$23.75	1.5× median	Above Median
9	1225355860	$395K	$43.79	2.8× median	Above 75th
10	1093466088	$297K	$48.40	3.1× median	Top 10%
11	1104879576	$272K	$59.83	3.9× median	Top 10%
12	1376962811	$269K	$38.62	2.5× median	Above 75th
13	1093884926	$255K	$18.65	1.2× median	Above Median
14	Baystate Medical Center Inc Springfield, MA · General Acute Care Hospital	$247K	$61.29	3.9× median	Top 10%
15	1902276892	$245K	$23.31	1.5× median	Above Median
16	1164707998	$210K	$9.75	0.6× median	Below Median
17	Indiana University Health, Inc Indianapolis, IN · Durable Medical Equipment & Medical Supplies	$204K	$60.03	3.9× median	Top 10%
18	1952729659	$188K	$36.40	2.3× median	Above 75th
19	1598891855	$173K	$39.88	2.6× median	Above 75th
20	1710936836	$172K	$39.74	2.6× median	Above 75th

Showing top 20 of 691 providers billing this code

Related Procedures

V5261$90.9M V5257$27.1M V5256$7.8M V5264$7.3M V5265$4.4M

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