#2739 of 11K

81599

HCPCS Procedure Code

HCPCS code 81599 is the #2,739 most-billed Medicaid procedure code, with $3.9M in payments across 147K claims from 2018–2024. The national median cost per claim is $39.21. Costs vary widely — the 90th percentile is $157.53 per claim, 4.0× the median.

Total Paid

$3.9M

0.00% of all spending

Total Claims

147K

Providers

Avg Cost/Claim

$26

National Cost Distribution

How much do providers bill per claim for 81599? Based on 23 providers billing this code nationally.

Median

$39.21

Average

$61.40

Std Dev

$70.96

Max

$240.59

Percentile Distribution (Cost per Claim)

p10

$1.94

p25

$4.80

Median

$39.21

p75

$115.51

p90

$157.53

p95

$169.99

p99

$225.32

50% of providers bill between $4.80 and $115.51 per claim for this code.

90% bill between $1.94 and $157.53.

Top 1% bill above $225.32.

About This Procedure

HCPCS code 81599 was billed by 29 providers across 147K claims, totaling $3.9M in Medicaid payments from 2018–2024. This code was used for 99K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$39.21

Providers Billing

National Spending

$3.9M

Avg/Median Ratio

1.57×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for 81599

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1598314437	$1.3M	$159.10	4.1× median	Top 10%
2	1366720906	$846K	$48.59	1.2× median	Above Median
3	1235363052	$750K	$6.83	0.2× median	Below Median
4	1821253584	$520K	$151.24	3.9× median	Above 75th
5	1013973866	$135K	$143.97	3.7× median	Above 75th
6	Maricopa County Special Health Care District Phoenix, AZ · General Acute Care Hospital	$113K	$146.22	3.7× median	Above 75th
7	1538799358	$47K	$171.20	4.4× median	Top 10%
8	Myriad Genetic Laboratories, Inc. Salt Lake City, UT · Clinical Medical Laboratory	$45K	$240.59	6.1× median	Top 1%
9	Natera Inc. San Carlos, CA · Clinical Medical Laboratory	$42K	$87.04	2.2× median	Above Median
10	Laboratory Corporation Of America Holdings Burlington, NC · Clinical Medical Laboratory	$13K	$16.25	0.4× median	Below Median
11	1639713787	$11K	$39.21	1.0× median	Below Median
12	Charleston Area Medical Center Inc Charleston, WV · General Acute Care Hospital	$10K	$57.56	1.5× median	Above Median
13	1821091067	$8K	$44.81	1.1× median	Above Median
14	Laboratory Corporation Of America Holdings Raritan, NJ · Clinical Medical Laboratory	$3K	$1.90	0.0× median	Below Median
15	1215003603	$3K	$11.14	0.3× median	Below Median
16	Quest Diagnostics Clinical Laboratories Inc Tucker, GA · Clinical Medical Laboratory	$2K	$3.11	0.1× median	Below Median
17	Laboratory Corporation Of America San Diego, CA · Clinical Medical Laboratory	$2K	$2.11	0.1× median	Below Median
18	Montefiore Medical Center Bronx, NY · General Acute Care Hospital	$1K	$44.29	1.1× median	Above Median
19	1982021564	$518	$27.26	0.7× median	Below Median
20	The Lowell General Hospital Lowell, MA · Pharmacy, Institutional Pharmacy	$358	$2.21	0.1× median	Below Median

Showing top 20 of 29 providers billing this code

Related Procedures

81595$10.4M 81596$6.3M

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