#1541 of 11K

81405

HCPCS Procedure Code

HCPCS code 81405 is the #1,541 most-billed Medicaid procedure code, with $19.7M in payments across 523K claims from 2018–2024. The national median cost per claim is $55.02. Costs vary widely — the 90th percentile is $230.25 per claim, 4.2× the median.

Total Paid

$19.7M

0.00% of all spending

Total Claims

523K

Providers

141

Avg Cost/Claim

$38

National Cost Distribution

How much do providers bill per claim for 81405? Based on 100 providers billing this code nationally.

Median

$55.02

Average

$101.04

Std Dev

$128.38

Max

$809.51

Percentile Distribution (Cost per Claim)

p10

$5.89

p25

$17.01

Median

$55.02

p75

$157.94

p90

$230.25

p95

$342.67

p99

$548.82

50% of providers bill between $17.01 and $157.94 per claim for this code.

90% bill between $5.89 and $230.25.

Top 1% bill above $548.82.

About This Procedure

HCPCS code 81405 was billed by 141 providers across 523K claims, totaling $19.7M in Medicaid payments from 2018–2024. This code was used for 443K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$55.02

Providers Billing

100

National Spending

$19.7M

Avg/Median Ratio

1.84×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for 81405

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Natera Inc. San Carlos, CA · Clinical Medical Laboratory	$6.4M	$20.15	0.4× median	Below Median
2	1790023547	$2.2M	$289.97	5.3× median	Top 10%
3	Invitae Corporation San Francisco, CA · Clinical Medical Laboratory	$2.1M	$42.54	0.8× median	Below Median
4	Genedx Llc Gaithersburg, MD · Medical Genetics, Ph.D. Medical Genetics	$1.7M	$74.75	1.4× median	Above Median
5	1013973866	$954K	$55.11	1.0× median	Above Median
6	1063892396	$722K	$158.89	2.9× median	Above 75th
7	1235528225	$651K	$21.49	0.4× median	Below Median
8	1326484569	$500K	$69.89	1.3× median	Above Median
9	1689971822	$499K	$342.18	6.2× median	Top 10%
10	1861568784	$452K	$163.40	3.0× median	Above 75th
11	Speciality Screening Llc Wauwatosa, WI · Clinical Medical Laboratory	$440K	$286.28	5.2× median	Top 10%
12	1184045619	$303K	$32.60	0.6× median	Below Median
13	Bioconfirm Laboratories Llc Doraville, GA · Clinical Medical Laboratory	$240K	$98.49	1.8× median	Above Median
14	1518415991	$212K	$19.12	0.3× median	Below Median
15	New York City Health And Hospitals Corporation Elmhurst, NY · Internal Medicine	$210K	$208.09	3.8× median	Above 75th
16	1003221904	$198K	$133.28	2.4× median	Above Median
17	Laboratory Corporation Of America Holdings Research Triangle Park, NC · Clinical Medical Laboratory	$170K	$60.67	1.1× median	Above Median
18	1659726487	$169K	$227.43	4.1× median	Above 75th
19	1639577091	$153K	$121.76	2.2× median	Above Median
20	1629109137	$130K	$809.51	14.7× median	Top 1%

Showing top 20 of 141 providers billing this code

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