#2480 of 11K

V5011

HCPCS Procedure Code

HCPCS code V5011 is the #2,480 most-billed Medicaid procedure code, with $5.5M in payments across 152K claims from 2018–2024. The national median cost per claim is $36.19. Costs vary widely — the 90th percentile is $98.60 per claim, 2.7× the median.

Total Paid

$5.5M

0.00% of all spending

Total Claims

152K

Providers

199

Avg Cost/Claim

$36

National Cost Distribution

How much do providers bill per claim for V5011? Based on 193 providers billing this code nationally.

Median

$36.19

Average

$50.49

Std Dev

$56.06

Max

$621.54

Percentile Distribution (Cost per Claim)

p10

$10.70

p25

$28.38

Median

$36.19

p75

$59.61

p90

$98.60

p95

$120.22

p99

$202.18

50% of providers bill between $28.38 and $59.61 per claim for this code.

90% bill between $10.70 and $98.60.

Top 1% bill above $202.18.

About This Procedure

HCPCS code V5011 was billed by 199 providers across 152K claims, totaling $5.5M in Medicaid payments from 2018–2024. This code was used for 129K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$36.19

Providers Billing

193

National Spending

$5.5M

Avg/Median Ratio

1.40×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for V5011

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1538457957	$608K	$37.87	1.0× median	Above Median
2	Los Angeles Unified School District Los Angeles, CA · Social Worker School	$590K	$32.20	0.9× median	Below Median
3	1194136424	$311K	$34.03	0.9× median	Below Median
4	1750621553	$179K	$45.34	1.3× median	Above Median
5	1710936836	$155K	$59.63	1.6× median	Above 75th
6	Alaska Native Tribal Health Consortium Anchorage, AK · General Acute Care Hospital	$152K	$287.44	7.9× median	Top 1%
7	1902851470	$142K	$45.51	1.3× median	Above Median
8	1215006150	$137K	$109.21	3.0× median	Top 10%
9	1659681823	$128K	$48.61	1.3× median	Above Median
10	1750336848	$114K	$62.70	1.7× median	Above 75th
11	District Medical Group, Inc Phoenix, AZ · Anesthesiology	$112K	$21.50	0.6× median	Below Median
12	1194886747	$108K	$111.33	3.1× median	Top 10%
13	1871798710	$106K	$38.75	1.1× median	Above Median
14	1336354794	$96K	$44.90	1.2× median	Above Median
15	1033527957	$90K	$129.18	3.6× median	Top 10%
16	1619252244	$84K	$28.38	0.8× median	Below Median
17	1144477266	$82K	$19.55	0.5× median	Below Median
18	1376108712	$81K	$43.52	1.2× median	Above Median
19	1447207287	$79K	$58.72	1.6× median	Above Median
20	1619518214	$70K	$61.58	1.7× median	Above 75th

Showing top 20 of 199 providers billing this code

Related Procedures

V5008$11.0M V5014$6.1M V5010$5.2M V5020$2.2M

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