#2044 of 11K

E0261

HCPCS Procedure Code

HCPCS code E0261 is the #2,044 most-billed Medicaid procedure code, with $9.7M in payments across 402K claims from 2018–2024. The national median cost per claim is $19.15. Costs vary widely — the 90th percentile is $49.15 per claim, 2.6× the median.

Total Paid

$9.7M

0.00% of all spending

Total Claims

402K

Providers

342

Avg Cost/Claim

$24

National Cost Distribution

How much do providers bill per claim for E0261? Based on 338 providers billing this code nationally.

Median

$19.15

Average

$25.06

Std Dev

$24.27

Max

$229.57

Percentile Distribution (Cost per Claim)

p10

$5.38

p25

$10.20

Median

$19.15

p75

$31.38

p90

$49.15

p95

$63.96

p99

$112.85

50% of providers bill between $10.20 and $31.38 per claim for this code.

90% bill between $5.38 and $49.15.

Top 1% bill above $112.85.

About This Procedure

HCPCS code E0261 was billed by 342 providers across 402K claims, totaling $9.7M in Medicaid payments from 2018–2024. This code was used for 358K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$19.15

Providers Billing

338

National Spending

$9.7M

Avg/Median Ratio

1.31×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for E0261

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Med Star Surgical & Breathing Equipment Inc. Bronx, NY · Prosthetic/Orthotic Supplier	$1.6M	$34.15	1.8× median	Above 75th
2	1093716334	$566K	$20.40	1.1× median	Above Median
3	Integra Partners Llc Troy, MI · Orthotic Fitter	$471K	$42.49	2.2× median	Above 75th
4	1861576282	$367K	$80.10	4.2× median	Top 10%
5	1023017647	$219K	$12.10	0.6× median	Below Median
6	1447406111	$211K	$28.51	1.5× median	Above Median
7	1760686117	$211K	$36.29	1.9× median	Above 75th
8	1144371204	$198K	$18.56	1.0× median	Below Median
9	1497703516	$174K	$90.36	4.7× median	Top 10%
10	1902934250	$159K	$18.76	1.0× median	Below Median
11	1851456180	$158K	$25.69	1.3× median	Above Median
12	1376612895	$156K	$27.11	1.4× median	Above Median
13	1821418187	$135K	$17.24	0.9× median	Below Median
14	1871710715	$123K	$24.97	1.3× median	Above Median
15	1922006741	$123K	$48.08	2.5× median	Above 75th
16	1144700303	$111K	$49.02	2.6× median	Above 75th
17	1568442283	$101K	$55.65	2.9× median	Top 10%
18	1912092594	$98K	$37.61	2.0× median	Above 75th
19	1437185626	$93K	$29.79	1.6× median	Above Median
20	1306990619	$93K	$47.21	2.5× median	Above 75th

Showing top 20 of 342 providers billing this code

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