#4545 of 11K

86331

HCPCS Procedure Code

HCPCS code 86331 is the #4,545 most-billed Medicaid procedure code, with $523K in payments across 59K claims from 2018–2024. The national median cost per claim is $7.35. Costs vary widely — the 90th percentile is $14.80 per claim, 2.0× the median.

Total Paid

$523K

0.00% of all spending

Total Claims

59K

Providers

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for 86331? Based on 35 providers billing this code nationally.

Median

$7.35

Average

$7.61

Std Dev

$5.51

Max

$19.48

Percentile Distribution (Cost per Claim)

p10

$0.57

p25

$2.47

Median

$7.35

p75

$11.32

p90

$14.80

p95

$15.85

p99

$18.95

50% of providers bill between $2.47 and $11.32 per claim for this code.

90% bill between $0.57 and $14.80.

Top 1% bill above $18.95.

About This Procedure

HCPCS code 86331 was billed by 42 providers across 59K claims, totaling $523K in Medicaid payments from 2018–2024. This code was used for 55K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$7.35

Providers Billing

National Spending

$523K

Avg/Median Ratio

1.04×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 86331

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Kern County Hospital Authority Bakersfield, CA · General Acute Care Hospital	$192K	$11.25	1.5× median	Above Median
2	1457341851	$174K	$8.22	1.1× median	Above Median
3	1427176569	$97K	$14.97	2.0× median	Top 10%
4	Laboratory Corporation Of America Holdings Burlington, NC · Clinical Medical Laboratory	$19K	$7.33	1.0× median	Below Median
5	1891873303	$5K	$14.83	2.0× median	Top 10%
6	University Of Kentucky Lexington, KY · General Acute Care Hospital	$5K	$14.74	2.0× median	Above 75th
7	1811417553	$5K	$11.25	1.5× median	Above Median
8	1700949336	$5K	$9.25	1.3× median	Above Median
9	Northwell Health Laboratories New Hyde Park, NY · Clinical Medical Laboratory	$2K	$13.16	1.8× median	Above 75th
10	1881626943	$2K	$11.40	1.6× median	Above 75th
11	1104829159	$2K	$2.90	0.4× median	Below Median
12	Maricopa County Special Health Care District Phoenix, AZ · General Acute Care Hospital	$2K	$2.18	0.3× median	Below Median
13	1750384079	$2K	$17.91	2.4× median	Top 10%
14	Sunrise Medical Laboratories, Inc. Hicksville, NY · Clinical Medical Laboratory	$2K	$6.52	0.9× median	Below Median
15	1538157508	$2K	$7.57	1.0× median	Above Median
16	1891892535	$1K	$14.22	1.9× median	Above 75th
17	1104906569	$1K	$0.93	0.1× median	Below Median
18	1144277633	$758	$0.22	0.0× median	Below Median
19	1023253556	$549	$5.90	0.8× median	Below Median
20	1821442864	$452	$9.42	1.3× median	Above Median

Showing top 20 of 42 providers billing this code

Related Procedures

86328$22.3M 86334$11.0M 86336$9.8M 86341$2.7M 86335$1.6M

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