#2805 of 11K

V5267

HCPCS Procedure Code

HCPCS code V5267 is the #2,805 most-billed Medicaid procedure code, with $3.5M in payments across 58K claims from 2018–2024. The national median cost per claim is $28.85. Costs vary widely — the 90th percentile is $119.60 per claim, 4.1× the median.

Total Paid

$3.5M

0.00% of all spending

Total Claims

58K

Providers

102

Avg Cost/Claim

$61

National Cost Distribution

How much do providers bill per claim for V5267? Based on 98 providers billing this code nationally.

Median

$28.85

Average

$58.19

Std Dev

$103.71

Max

$807.99

Percentile Distribution (Cost per Claim)

p10

$6.47

p25

$10.33

Median

$28.85

p75

$52.45

p90

$119.60

p95

$228.78

p99

$412.24

50% of providers bill between $10.33 and $52.45 per claim for this code.

90% bill between $6.47 and $119.60.

Top 1% bill above $412.24.

About This Procedure

HCPCS code V5267 was billed by 102 providers across 58K claims, totaling $3.5M in Medicaid payments from 2018–2024. This code was used for 49K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$28.85

Providers Billing

National Spending

$3.5M

Avg/Median Ratio

2.02×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for V5267

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1932129848	$1.9M	$807.99	28.0× median	Top 1%
2	1194136424	$347K	$53.08	1.8× median	Above 75th
3	1538457957	$214K	$43.37	1.5× median	Above Median
4	1376962811	$90K	$19.05	0.7× median	Below Median
5	1427366368	$78K	$38.73	1.3× median	Above Median
6	1215993704	$66K	$86.86	3.0× median	Above 75th
7	1225355860	$63K	$10.17	0.4× median	Below Median
8	1649319724	$52K	$31.49	1.1× median	Above Median
9	1033585302	$52K	$35.24	1.2× median	Above Median
10	1093466088	$48K	$9.48	0.3× median	Below Median
11	District Medical Group, Inc Phoenix, AZ · Anesthesiology	$41K	$35.57	1.2× median	Above Median
12	1013932557	$40K	$224.46	7.8× median	Top 10%
13	1649758137	$37K	$183.42	6.4× median	Top 10%
14	1235340274	$32K	$78.51	2.7× median	Above 75th
15	1760841191	$30K	$299.68	10.4× median	Top 10%
16	1962400036	$30K	$44.82	1.6× median	Above Median
17	1952746265	$29K	$31.98	1.1× median	Above Median
18	1972943736	$26K	$50.57	1.8× median	Above Median
19	1427514710	$21K	$26.71	0.9× median	Below Median
20	Umass Memorial Medical Center, Inc. Worcester, MA · General Acute Care Hospital	$21K	$24.48	0.8× median	Below Median

Showing top 20 of 102 providers billing this code

Related Procedures

V5261$90.9M V5257$27.1M V5266$18.9M V5264$7.3M V5265$4.4M

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