#390 of 11K

81528

Oncology, colorectal screening, quantitative analysis of stool DNA

Oncology, colorectal screening, quantitative analysis of stool DNA is the #390 most-billed Medicaid procedure code, with $277.0M in payments across 985K claims from 2018–2024. The national median cost per claim is $13.70. Costs vary widely — the 90th percentile is $250.26 per claim, 18.3× the median.

Total Paid

$277.0M

0.03% of all spending

Total Claims

985K

Providers

Avg Cost/Claim

$281

National Cost Distribution

How much do providers bill per claim for 81528? Based on 23 providers billing this code nationally.

Median

$13.70

Average

$58.11

Std Dev

$98.14

Max

$282.63

Percentile Distribution (Cost per Claim)

p10

$0.00

p25

$0.26

Median

$13.70

p75

$53.19

p90

$250.26

p95

$276.24

p99

$281.70

50% of providers bill between $0.26 and $53.19 per claim for this code.

90% bill between $0.00 and $250.26.

Top 1% bill above $281.70.

About This Procedure

HCPCS code 81528 (Oncology, colorectal screening, quantitative analysis of stool DNA) was billed by 34 providers across 985K claims, totaling $277.0M in Medicaid payments from 2018–2024. This code was used for 928K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$13.70

Providers Billing

National Spending

$277.0M

Avg/Median Ratio

4.24×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for 81528

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Exact Sciences Laboratories Llc Madison, WI · Clinical Medical Laboratory	$276.2M	$282.63	20.6× median	Top 1%
2	1487296307	$652K	$256.59	18.7× median	Top 10%
3	Mayo Collaborative Services, Inc Rochester, MN · Clinical Medical Laboratory	$82K	$224.93	16.4× median	Above 75th
4	1083249577	$17K	$278.42	20.3× median	Top 10%
5	1043469042	$8K	$15.77	1.2× median	Above Median
6	1023287679	$5K	$3.27	0.2× median	Below Median
7	1205167384	$4K	$57.86	4.2× median	Above 75th
8	1215257878	$3K	$19.77	1.4× median	Above Median
9	1225251507	$1K	$48.51	3.5× median	Above Median
10	1518035799	$1K	$92.31	6.7× median	Above 75th
11	1194799676	$1K	$13.70	1.0× median	Below Median
12	1720526502	$446	$18.57	1.4× median	Above Median
13	1942645247	$225	$0.45	0.0× median	Below Median
14	1982604310	$200	$16.67	1.2× median	Above Median
15	1346607603	$100	$3.70	0.3× median	Below Median
16	1245253160	$75	$2.42	0.2× median	Below Median
17	1962594812	$30	$0.77	0.1× median	Below Median
18	1639346869	$11	$0.08	0.0× median	Below Median
19	1710254313	$1	$0.01	0.0× median	Below Median
20	1699216622	$1	$0.00	0.0× median	Below Median

Showing top 20 of 34 providers billing this code

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81519$95.8M 81521$4.6M 81518$3.6M 81529$1.0M 81538$15K

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