81255
HCPCS Procedure Code
HCPCS code 81255 is the #2,265 most-billed Medicaid procedure code, with $7.2M in payments across 480K claims from 2018–2024. The national median cost per claim is $18.13. Costs vary widely — the 90th percentile is $44.62 per claim, 2.5× the median.
Total Paid
$7.2M
0.00% of all spending
Total Claims
480K
Providers
62
Avg Cost/Claim
$15
National Cost Distribution
How much do providers bill per claim for 81255? Based on 52 providers billing this code nationally.
Median
$18.13
Average
$35.82
Std Dev
$67.67
Max
$425.00
Percentile Distribution (Cost per Claim)
50% of providers bill between $7.85 and $38.54 per claim for this code.
90% bill between $3.47 and $44.62.
Top 1% bill above $343.40.
About This Procedure
HCPCS code 81255 was billed by 62 providers across 480K claims, totaling $7.2M in Medicaid payments from 2018–2024. This code was used for 418K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$18.13
Providers Billing
52
National Spending
$7.2M
Avg/Median Ratio
1.98×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for 81255
| # | Provider | Total Paid |
|---|---|---|
| 1 | Natera Inc. San Carlos, CA · Clinical Medical Laboratory | $2.7M |
| 2 | 1790023547 | $1.4M |
| 3 | 1114222817 | $997K |
| 4 | 1689975021 | $376K |
| 5 | Myriad Women's Health, Inc. South San Francisco, CA · Clinical Medical Laboratory | $294K |
| 6 | Laboratory Corporation Of America Holdings Burlington, NC · Clinical Medical Laboratory | $274K |
| 7 | 1235528225 | $239K |
| 8 | 1326484569 | $213K |
| 9 | Laboratory Corporation Of America Holdings Research Triangle Park, NC · Clinical Medical Laboratory | $130K |
| 10 | 1518415991 | $84K |
| 11 | Laboratory Corporation Of America Holdings Dublin, OH · Clinical Medical Laboratory | $71K |
| 12 | Laboratory Corporation Of America Holdings Raritan, NJ · Clinical Medical Laboratory | $51K |
| 13 | Laboratory Corporation Of America Holdings Birmingham, AL · Clinical Medical Laboratory | $49K |
| 14 | New York City Health And Hospitals Corporation Elmhurst, NY · Internal Medicine | $47K |
| 15 | New York City Health And Hospitals Corporation Brooklyn, NY · Internal Medicine | $28K |
| 16 | 1093793200 | $24K |
| 17 | New York City Health And Hospitals Corporation New York, NY · Internal Medicine | $24K |
| 18 | Sherman Abrams Laboratory Inc Brooklyn, NY · Clinical Medical Laboratory | $24K |
| 19 | 1013924372 | $23K |
| 20 | 1063892396 | $23K |
Showing top 20 of 62 providers billing this code