#5975 of 11K

OP255

HCPCS Procedure Code

HCPCS code OP255 is the #5,975 most-billed Medicaid procedure code, with $111K in payments across 30K claims from 2018–2024. The national median cost per claim is $2.61. Costs vary widely — the 90th percentile is $6.24 per claim, 2.4× the median.

Total Paid

$111K

0.00% of all spending

Total Claims

30K

Providers

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for OP255? Based on 27 providers billing this code nationally.

Median

$2.61

Average

$4.29

Std Dev

$6.28

Max

$29.11

Percentile Distribution (Cost per Claim)

p10

$0.53

p25

$1.02

Median

$2.61

p75

$4.85

p90

$6.24

p95

$15.86

p99

$26.72

50% of providers bill between $1.02 and $4.85 per claim for this code.

90% bill between $0.53 and $6.24.

Top 1% bill above $26.72.

About This Procedure

HCPCS code OP255 was billed by 27 providers across 30K claims, totaling $111K in Medicaid payments from 2018–2024. This code was used for 26K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$2.61

Providers Billing

National Spending

$111K

Avg/Median Ratio

1.64×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for OP255

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	University Hospital Newark, NJ · General Acute Care Hospital	$33K	$3.55	1.4× median	Above Median
2	Jersey City Medical Center Jersey City, NJ · General Acute Care Hospital	$24K	$5.84	2.2× median	Above 75th
3	Ahs Hospital Corp. Morristown, NJ · General Acute Care Hospital	$14K	$2.43	0.9× median	Below Median
4	Virtua - West Jersey Health System Inc. Voorhees, NJ · General Acute Care Hospital	$9K	$19.92	7.6× median	Top 10%
5	1225133473	$6K	$5.45	2.1× median	Above 75th
6	1134125016	$5K	$29.11	11.2× median	Top 1%
7	Ahs Hospital Corp. Summit, NJ · General Acute Care Hospital	$5K	$2.61	1.0× median	Above Median
8	1013010917	$4K	$3.58	1.4× median	Above Median
9	1982720249	$3K	$2.04	0.8× median	Below Median
10	1609983790	$3K	$2.64	1.0× median	Above Median
11	Robert Wood Johnson University Hospital, Inc New Brunswick, NJ · General Acute Care Hospital	$1K	$1.80	0.7× median	Below Median
12	1306817978	$1K	$6.37	2.4× median	Top 10%
13	Atlanticare Regional Medical Center Pomona, NJ · General Acute Care Hospital	$971	$0.59	0.2× median	Below Median
14	1811994809	$307	$3.01	1.2× median	Above Median
15	Newark Beth Israel Medical Center Inc Newark, NJ · General Acute Care Hospital	$230	$1.11	0.4× median	Below Median
16	1700351947	$203	$6.16	2.4× median	Above 75th
17	1689714255	$162	$4.25	1.6× median	Above Median
18	1518969419	$90	$0.93	0.4× median	Below Median
19	1568825545	$79	$6.05	2.3× median	Above 75th
20	Cooperman Barnabas Medical Center Inc Livingston, NJ · General Acute Care Hospital	$69	$0.13	0.0× median	Below Median

Showing top 20 of 27 providers billing this code

Related Procedures

OP250Orthotic or prosthetic procedure, not otherwise classified$72.5M OP259$8.9M OP258$5.0M OP251$1.7M OP252$176K

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