#3972 of 11K

43281

HCPCS Procedure Code

HCPCS code 43281 is the #3,972 most-billed Medicaid procedure code, with $969K in payments across 2K claims from 2018–2024. The national median cost per claim is $558.72.

Total Paid

$969K

0.00% of all spending

Total Claims

Providers

Avg Cost/Claim

$521

National Cost Distribution

How much do providers bill per claim for 43281? Based on 24 providers billing this code nationally.

Median

$558.72

Average

$548.75

Std Dev

$254.78

Max

$1,039.23

Percentile Distribution (Cost per Claim)

p10

$236.78

p25

$384.60

Median

$558.72

p75

$673.07

p90

$902.07

p95

$988.08

p99

$1,029.66

50% of providers bill between $384.60 and $673.07 per claim for this code.

90% bill between $236.78 and $902.07.

Top 1% bill above $1,029.66.

About This Procedure

HCPCS code 43281 was billed by 24 providers across 2K claims, totaling $969K in Medicaid payments from 2018–2024. This code was used for 1K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$558.72

Providers Billing

National Spending

$969K

Avg/Median Ratio

0.98×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 43281

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1407272636	$211K	$1,039.23	1.9× median	Top 1%
2	1821450545	$133K	$630.45	1.1× median	Above Median
3	1699823450	$108K	$453.61	0.8× median	Below Median
4	Spectrum Health Primary Care Partners Grand Rapids, MI · Psychologist, Clinical Child & Adolescent	$93K	$267.85	0.5× median	Below Median
5	1740710250	$63K	$545.27	1.0× median	Below Median
6	1902465065	$53K	$624.70	1.1× median	Above Median
7	1619491446	$36K	$674.06	1.2× median	Above 75th
8	1548501620	$33K	$394.15	0.7× median	Below Median
9	1326275363	$31K	$612.03	1.1× median	Above Median
10	1184612467	$27K	$997.62	1.8× median	Top 10%
11	1336174366	$25K	$454.55	0.8× median	Below Median
12	1730387010	$23K	$525.87	0.9× median	Below Median
13	1114539731	$21K	$302.66	0.5× median	Below Median
14	1609847367	$19K	$195.49	0.3× median	Below Median
15	Uofl Health-louisville Inc Louisville, KY · Psychiatric Hospital	$16K	$665.61	1.2× median	Above Median
16	1528014164	$14K	$933.99	1.7× median	Top 10%
17	1699724872	$13K	$355.93	0.6× median	Below Median
18	1104875970	$11K	$433.14	0.8× median	Below Median
19	1720028772	$11K	$827.61	1.5× median	Above 75th
20	1255539193	$9K	$734.41	1.3× median	Above 75th

Showing top 20 of 24 providers billing this code

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