12011
HCPCS Procedure Code
HCPCS code 12011 is the #1,097 most-billed Medicaid procedure code, with $41.2M in payments across 393K claims from 2018–2024. The national median cost per claim is $67.02. Costs vary widely — the 90th percentile is $247.83 per claim, 3.7× the median.
Total Paid
$41.2M
0.00% of all spending
Total Claims
393K
Providers
941
Avg Cost/Claim
$105
National Cost Distribution
How much do providers bill per claim for 12011? Based on 892 providers billing this code nationally.
Median
$67.02
Average
$107.96
Std Dev
$110.26
Max
$580.57
Percentile Distribution (Cost per Claim)
50% of providers bill between $30.38 and $163.22 per claim for this code.
90% bill between $7.49 and $247.83.
Top 1% bill above $500.27.
About This Procedure
HCPCS code 12011 was billed by 941 providers across 393K claims, totaling $41.2M in Medicaid payments from 2018–2024. This code was used for 375K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$67.02
Providers Billing
892
National Spending
$41.2M
Avg/Median Ratio
1.61×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for 12011
| # | Provider | Total Paid |
|---|---|---|
| 1 | The New York And Presbyterian Hospital New York, NY · General Acute Care Hospital | $1.0M |
| 2 | Children's Hospital Washington, DC · General Acute Care Hospital Children | $716K |
| 3 | Long Island Jewish Medical Center New Hyde Park, NY · General Acute Care Hospital | $710K |
| 4 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $678K |
| 5 | Suny Health Science Center At Syracuse Syracuse, NY · General Acute Care Hospital | $667K |
| 6 | The Brookdale Hospital Medical Center Brooklyn, NY · General Acute Care Hospital | $607K |
| 7 | Maimonides Medical Center Brooklyn, NY · General Acute Care Hospital | $597K |
| 8 | Childrens Hospital Of The Kings Daughters Inc Norfolk, VA · Social Worker, Clinical | $597K |
| 9 | 1306952726 | $591K |
| 10 | Newyork-presbyterian-queens Flushing, NY · General Acute Care Hospital | $551K |
| 11 | University Of Rochester Rochester, NY · General Acute Care Hospital | $532K |
| 12 | Rochester General Hospital Rochester, NY · Dentist, General Practice | $499K |
| 13 | 1376577247 | $496K |
| 14 | Children's Hospital Medical Center Cincinnati, OH · Clinic/Center, Primary Care | $455K |
| 15 | The New York And Presbyterian Hospital New York, NY · General Acute Care Hospital | $444K |
| 16 | 1841231461 | $440K |
| 17 | Maricopa County Special Health Care District Phoenix, AZ · General Acute Care Hospital | $439K |
| 18 | 1407877137 | $435K |
| 19 | 1053373480 | $429K |
| 20 | Baystate Medical Center Inc Springfield, MA · General Acute Care Hospital | $425K |
Showing top 20 of 941 providers billing this code