#1816 of 11K

81225

HCPCS Procedure Code

HCPCS code 81225 is the #1,816 most-billed Medicaid procedure code, with $13.4M in payments across 435K claims from 2018–2024. The national median cost per claim is $23.49. Costs vary widely — the 90th percentile is $152.64 per claim, 6.5× the median.

Total Paid

$13.4M

0.00% of all spending

Total Claims

435K

Providers

142

Avg Cost/Claim

$31

National Cost Distribution

How much do providers bill per claim for 81225? Based on 96 providers billing this code nationally.

Median

$23.49

Average

$50.72

Std Dev

$66.51

Max

$272.94

Percentile Distribution (Cost per Claim)

p10

$2.37

p25

$7.09

Median

$23.49

p75

$57.56

p90

$152.64

p95

$220.38

p99

$257.57

50% of providers bill between $7.09 and $57.56 per claim for this code.

90% bill between $2.37 and $152.64.

Top 1% bill above $257.57.

About This Procedure

HCPCS code 81225 was billed by 142 providers across 435K claims, totaling $13.4M in Medicaid payments from 2018–2024. This code was used for 392K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$23.49

Providers Billing

National Spending

$13.4M

Avg/Median Ratio

2.16×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for 81225

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1235363052	$10.1M	$29.22	1.2× median	Above Median
2	Millennium Health Llc San Diego, CA · Clinical Medical Laboratory	$899K	$75.24	3.2× median	Above 75th
3	1467850859	$871K	$31.91	1.4× median	Above Median
4	Gravity Diagnostics, Llc Covington, KY · Clinical Medical Laboratory	$155K	$35.97	1.5× median	Above Median
5	1821360017	$91K	$195.00	8.3× median	Top 10%
6	1639541295	$83K	$54.28	2.3× median	Above Median
7	1750373908	$78K	$26.07	1.1× median	Above Median
8	1437585262	$78K	$25.72	1.1× median	Above Median
9	Accu Reference Medical Lab, Llc Linden, NJ · Clinical Medical Laboratory	$76K	$43.50	1.9× median	Above Median
10	1124438528	$73K	$29.49	1.3× median	Above Median
11	1275971707	$53K	$16.36	0.7× median	Below Median
12	1043271539	$52K	$50.83	2.2× median	Above Median
13	Speciality Screening Llc Wauwatosa, WI · Clinical Medical Laboratory	$47K	$272.94	11.6× median	Top 1%
14	1497175905	$44K	$32.16	1.4× median	Above Median
15	1790021517	$44K	$146.16	6.2× median	Above 75th
16	1790023547	$43K	$59.85	2.5× median	Above 75th
17	1760840482	$41K	$224.49	9.6× median	Top 10%
18	Rca Laboratory Services, Llc Glen Allen, VA · Clinical Medical Laboratory	$39K	$117.17	5.0× median	Above 75th
19	1669836227	$30K	$30.63	1.3× median	Above Median
20	1215272406	$29K	$17.54	0.7× median	Below Median

Showing top 20 of 142 providers billing this code

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