86001
HCPCS Procedure Code
HCPCS code 86001 is the #5,011 most-billed Medicaid procedure code, with $321K in payments across 33K claims from 2018–2024. The national median cost per claim is $6.52. Costs vary widely — the 90th percentile is $50.44 per claim, 7.7× the median.
Total Paid
$321K
0.00% of all spending
Total Claims
33K
Providers
51
Avg Cost/Claim
$10
National Cost Distribution
How much do providers bill per claim for 86001? Based on 48 providers billing this code nationally.
Median
$6.52
Average
$23.09
Std Dev
$55.26
Max
$302.39
Percentile Distribution (Cost per Claim)
50% of providers bill between $2.93 and $17.26 per claim for this code.
90% bill between $0.77 and $50.44.
Top 1% bill above $272.57.
About This Procedure
HCPCS code 86001 was billed by 51 providers across 33K claims, totaling $321K in Medicaid payments from 2018–2024. This code was used for 30K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$6.52
Providers Billing
48
National Spending
$321K
Avg/Median Ratio
3.54×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for 86001
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1114963956 | $86K |
| 2 | Unilab Corporation West Hills, CA · Clinical Medical Laboratory | $43K |
| 3 | Quest Diagnostics Llc Il Wood Dale, IL · Clinical Medical Laboratory | $26K |
| 4 | 1396790119 | $21K |
| 5 | Bioreference Health Llc Elmwood Park, NJ · Clinical Medical Laboratory | $17K |
| 6 | Sonora Quest Laboratories Llc Phoenix, AZ · Clinical Medical Laboratory | $15K |
| 7 | Quest Diagnostics Clinical Laboratories Inc Miramar, FL · Clinical Medical Laboratory | $13K |
| 8 | Upmc Children's Hospital Of Pittsburgh Pittsburgh, PA · Clinic/Center | $11K |
| 9 | 1568868446 | $10K |
| 10 | 1316983158 | $10K |
| 11 | 1447317896 | $9K |
| 12 | 1235186800 | $9K |
| 13 | Quest Diagnostics Clinical Laboratories Inc Tucker, GA · Clinical Medical Laboratory | $9K |
| 14 | Quest Diagnostics Clinical Laboratories Inc Irving, TX · Clinical Medical Laboratory | $8K |
| 15 | 1700120318 | $6K |
| 16 | Laboratory Corporation Of America Holdings Burlington, NC · Clinical Medical Laboratory | $4K |
| 17 | 1871566521 | $3K |
| 18 | 1811997711 | $3K |
| 19 | 1073587937 | $2K |
| 20 | 1306897335 | $2K |
Showing top 20 of 51 providers billing this code