#4087 of 11K

81007

HCPCS Procedure Code

HCPCS code 81007 is the #4,087 most-billed Medicaid procedure code, with $863K in payments across 157K claims from 2018–2024. The national median cost per claim is $3.40. Costs vary widely — the 90th percentile is $22.57 per claim, 6.6× the median.

Total Paid

$863K

0.00% of all spending

Total Claims

157K

Providers

125

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for 81007? Based on 109 providers billing this code nationally.

Median

$3.40

Average

$7.47

Std Dev

$8.39

Max

$26.98

Percentile Distribution (Cost per Claim)

p10

$0.33

p25

$0.88

Median

$3.40

p75

$12.57

p90

$22.57

p95

$25.57

p99

$26.65

50% of providers bill between $0.88 and $12.57 per claim for this code.

90% bill between $0.33 and $22.57.

Top 1% bill above $26.65.

About This Procedure

HCPCS code 81007 was billed by 125 providers across 157K claims, totaling $863K in Medicaid payments from 2018–2024. This code was used for 132K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$3.40

Providers Billing

109

National Spending

$863K

Avg/Median Ratio

2.20×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for 81007

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1285615286	$180K	$23.82	7.0× median	Top 10%
2	1952357550	$102K	$21.31	6.3× median	Above 75th
3	1316938921	$72K	$2.56	0.8× median	Below Median
4	1699823617	$72K	$26.08	7.7× median	Top 10%
5	1053361352	$71K	$12.57	3.7× median	Above Median
6	1275547606	$71K	$19.55	5.8× median	Above 75th
7	1063461358	$44K	$25.82	7.6× median	Top 10%
8	1871807115	$33K	$2.16	0.6× median	Below Median
9	1053530758	$32K	$19.99	5.9× median	Above 75th
10	1154370443	$17K	$25.84	7.6× median	Top 10%
11	1528514221	$17K	$0.57	0.2× median	Below Median
12	1013004795	$15K	$13.99	4.1× median	Above 75th
13	1053762104	$13K	$13.69	4.0× median	Above 75th
14	1154687572	$11K	$5.24	1.5× median	Above Median
15	1942475793	$9K	$7.70	2.3× median	Above Median
16	1588089718	$9K	$26.68	7.8× median	Top 1%
17	1972625499	$8K	$2.23	0.7× median	Below Median
18	1740679943	$8K	$1.11	0.3× median	Below Median
19	1245542570	$7K	$1.50	0.4× median	Below Median
20	1740361690	$7K	$6.67	2.0× median	Above Median

Showing top 20 of 125 providers billing this code

Related Procedures

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