#2689 of 11K

81223

HCPCS Procedure Code

HCPCS code 81223 is the #2,689 most-billed Medicaid procedure code, with $4.1M in payments across 11K claims from 2018–2024. The national median cost per claim is $183.14. Costs vary widely — the 90th percentile is $702.08 per claim, 3.8× the median.

Total Paid

$4.1M

0.00% of all spending

Total Claims

11K

Providers

Avg Cost/Claim

$376

National Cost Distribution

How much do providers bill per claim for 81223? Based on 29 providers billing this code nationally.

Median

$183.14

Average

$362.95

Std Dev

$531.41

Max

$2,650.74

Percentile Distribution (Cost per Claim)

p10

$18.02

p25

$40.38

Median

$183.14

p75

$469.65

p90

$702.08

p95

$1,123.57

p99

$2,256.73

50% of providers bill between $40.38 and $469.65 per claim for this code.

90% bill between $18.02 and $702.08.

Top 1% bill above $2,256.73.

About This Procedure

HCPCS code 81223 was billed by 39 providers across 11K claims, totaling $4.1M in Medicaid payments from 2018–2024. This code was used for 10K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$183.14

Providers Billing

National Spending

$4.1M

Avg/Median Ratio

1.98×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for 81223

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1326484569	$1.6M	$2,650.74	14.5× median	Top 1%
2	1063892396	$1.1M	$641.71	3.5× median	Above 75th
3	Invitae Corporation San Francisco, CA · Clinical Medical Laboratory	$355K	$96.46	0.5× median	Below Median
4	Myriad Women's Health, Inc. South San Francisco, CA · Clinical Medical Laboratory	$332K	$511.10	2.8× median	Above 75th
5	1447436514	$106K	$181.18	1.0× median	Below Median
6	1659726487	$104K	$943.56	5.2× median	Top 10%
7	1457977209	$92K	$360.06	2.0× median	Above Median
8	1861568784	$88K	$143.91	0.8× median	Below Median
9	Speciality Screening Llc Wauwatosa, WI · Clinical Medical Laboratory	$82K	$481.49	2.6× median	Above 75th
10	1689975021	$79K	$546.37	3.0× median	Above 75th
11	Alameda Health System Oakland, CA · General Acute Care Hospital	$62K	$1,243.57	6.8× median	Top 10%
12	1609388842	$51K	$368.75	2.0× median	Above Median
13	1447843750	$44K	$58.50	0.3× median	Below Median
14	Laboratory Corporation Of America Holdings Research Triangle Park, NC · Clinical Medical Laboratory	$40K	$215.41	1.2× median	Above Median
15	1558067199	$12K	$432.47	2.4× median	Above Median
16	1275292294	$9K	$183.14	1.0× median	Above Median
17	1043271539	$8K	$469.65	2.6× median	Above Median
18	1396384251	$7K	$399.20	2.2× median	Above Median
19	1518713072	$6K	$241.97	1.3× median	Above Median
20	Bioconfirm Laboratories Llc Doraville, GA · Clinical Medical Laboratory	$5K	$117.71	0.6× median	Below Median

Showing top 20 of 39 providers billing this code

Related Procedures

81220CFTR gene analysis, common variants$458.2M 81229$84.5M 81226$18.3M 81225$13.4M 81227$5.8M

← All procedures Top providers →