81511
HCPCS Procedure Code
HCPCS code 81511 is the #926 most-billed Medicaid procedure code, with $57.7M in payments across 386K claims from 2018–2024. The national median cost per claim is $48.74. Costs vary widely — the 90th percentile is $146.86 per claim, 3.0× the median.
Total Paid
$57.7M
0.01% of all spending
Total Claims
386K
Providers
169
Avg Cost/Claim
$149
National Cost Distribution
How much do providers bill per claim for 81511? Based on 138 providers billing this code nationally.
Median
$48.74
Average
$66.39
Std Dev
$73.74
Max
$496.85
Percentile Distribution (Cost per Claim)
50% of providers bill between $19.20 and $90.58 per claim for this code.
90% bill between $2.34 and $146.86.
Top 1% bill above $385.64.
About This Procedure
HCPCS code 81511 was billed by 169 providers across 386K claims, totaling $57.7M in Medicaid payments from 2018–2024. This code was used for 335K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$48.74
Providers Billing
138
National Spending
$57.7M
Avg/Median Ratio
1.36×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 81511
| # | Provider | Total Paid |
|---|---|---|
| 1 | Genetic Disease Screening Program State Of Ca Richmond, CA · Clinical Medical Laboratory | $50.6M |
| 2 | Quest Diagnostics Clinical Laboratories Inc Miramar, FL · Clinical Medical Laboratory | $800K |
| 3 | Tricore Reference Laboratories Albuquerque, NM · Clinical Medical Laboratory | $775K |
| 4 | Bioreference Health Llc Elmwood Park, NJ · Clinical Medical Laboratory | $464K |
| 5 | Quest Diagnostics Incorporated Clifton, NJ · Clinical Medical Laboratory | $418K |
| 6 | 1891731626 | $368K |
| 7 | Quest Diagnostics Llc Il Wood Dale, IL · Clinical Medical Laboratory | $328K |
| 8 | Quest Diagnostics Clinical Laboratories Inc Tucker, GA · Clinical Medical Laboratory | $326K |
| 9 | Mayo Collaborative Services, Inc Rochester, MN · Clinical Medical Laboratory | $307K |
| 10 | 1548370745 | $275K |
| 11 | County Of Ventura Ventura, CA · Clinic/Center, Emergency Care | $255K |
| 12 | Labone Llc Lenexa, KS · Clinical Medical Laboratory | $249K |
| 13 | Medical University Hospital Authority Charleston, SC · General Acute Care Hospital | $227K |
| 14 | 1396813861 | $212K |
| 15 | Quest Diagnostics Massachusetts Llc Marlborough, MA · Clinical Medical Laboratory | $179K |
| 16 | Sunrise Medical Laboratories, Inc. Hicksville, NY · Clinical Medical Laboratory | $149K |
| 17 | Umass Memorial Medical Center, Inc. Worcester, MA · General Acute Care Hospital | $143K |
| 18 | Tricore Inc. Albuquerque, NM · Clinical Medical Laboratory | $129K |
| 19 | 1639123284 | $124K |
| 20 | Quest Diagnostics Clinical Laboratories Inc Irving, TX · Clinical Medical Laboratory | $93K |
Showing top 20 of 169 providers billing this code