43259
HCPCS Procedure Code
HCPCS code 43259 is the #3,499 most-billed Medicaid procedure code, with $1.6M in payments across 7K claims from 2018–2024. The national median cost per claim is $139.04. Costs vary widely — the 90th percentile is $363.14 per claim, 2.6× the median.
Total Paid
$1.6M
0.00% of all spending
Total Claims
7K
Providers
54
Avg Cost/Claim
$226
National Cost Distribution
How much do providers bill per claim for 43259? Based on 52 providers billing this code nationally.
Median
$139.04
Average
$185.56
Std Dev
$174.81
Max
$975.62
Percentile Distribution (Cost per Claim)
50% of providers bill between $90.81 and $204.16 per claim for this code.
90% bill between $68.15 and $363.14.
Top 1% bill above $859.16.
About This Procedure
HCPCS code 43259 was billed by 54 providers across 7K claims, totaling $1.6M in Medicaid payments from 2018–2024. This code was used for 7K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$139.04
Providers Billing
52
National Spending
$1.6M
Avg/Median Ratio
1.33×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 43259
| # | Provider | Total Paid |
|---|---|---|
| 1 | University Of California Irvine Orange, CA · General Acute Care Hospital | $455K |
| 2 | Yale New Haven Hospital New Haven, CT · General Acute Care Hospital | $292K |
| 3 | Unm Hospital Albuquerque, NM · General Acute Care Hospital | $120K |
| 4 | 1902854078 | $105K |
| 5 | Hartford Hospital Hartford, CT · General Acute Care Hospital | $88K |
| 6 | University Of Kentucky Lexington, KY · General Acute Care Hospital | $61K |
| 7 | 1831218627 | $60K |
| 8 | 1184821373 | $60K |
| 9 | Spectrum Health Primary Care Partners Grand Rapids, MI · Psychologist, Clinical Child & Adolescent | $37K |
| 10 | 1265489157 | $37K |
| 11 | 1720489370 | $33K |
| 12 | 1508968751 | $23K |
| 13 | Regents Of The University Of California San Diego, CA · General Acute Care Hospital | $21K |
| 14 | 1205909892 | $15K |
| 15 | 1003267196 | $13K |
| 16 | 1194099390 | $13K |
| 17 | 1861410581 | $12K |
| 18 | 1144471715 | $12K |
| 19 | 1275583205 | $11K |
| 20 | 1700287869 | $11K |
Showing top 20 of 54 providers billing this code