#2058 of 11K

J0571

HCPCS Procedure Code

HCPCS code J0571 is the #2,058 most-billed Medicaid procedure code, with $9.5M in payments across 844K claims from 2018–2024. The national median cost per claim is $7.96. Costs vary widely — the 90th percentile is $35.31 per claim, 4.4× the median.

Total Paid

$9.5M

0.00% of all spending

Total Claims

844K

Providers

Avg Cost/Claim

$11

National Cost Distribution

How much do providers bill per claim for J0571? Based on 61 providers billing this code nationally.

Median

$7.96

Average

$12.26

Std Dev

$15.02

Max

$73.18

Percentile Distribution (Cost per Claim)

p10

$1.14

p25

$2.24

Median

$7.96

p75

$14.42

p90

$35.31

p95

$45.90

p99

$61.15

50% of providers bill between $2.24 and $14.42 per claim for this code.

90% bill between $1.14 and $35.31.

Top 1% bill above $61.15.

About This Procedure

HCPCS code J0571 was billed by 72 providers across 844K claims, totaling $9.5M in Medicaid payments from 2018–2024. This code was used for 60K unique beneficiaries.

Fraud Risk Context

Injectable drug codes carry high per-claim costs and have been involved in drug diversion and upcoding schemes.

Source: HHS OIG Reports

Risk Assessment

Billing Statistics

Median Cost/Claim

$7.96

Providers Billing

National Spending

$9.5M

Avg/Median Ratio

1.54×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for J0571

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1427397074	$2.4M	$17.21	2.2× median	Above 75th
2	1225241441	$1.3M	$9.21	1.2× median	Above Median
3	1255942223	$1.0M	$53.14	6.7× median	Top 10%
4	1023621042	$739K	$42.85	5.4× median	Top 10%
5	Sunrise Treatment Center, Llc Cincinnati, OH · Clinic/Center, Adult Mental Health	$450K	$16.75	2.1× median	Above 75th
6	1588045462	$329K	$19.77	2.5× median	Above 75th
7	1558412320	$312K	$10.86	1.4× median	Above Median
8	1720594393	$304K	$45.01	5.7× median	Top 10%
9	1588929376	$272K	$5.89	0.7× median	Below Median
10	1265683049	$266K	$8.10	1.0× median	Above Median
11	1386783314	$251K	$6.56	0.8× median	Below Median
12	1538208566	$238K	$10.96	1.4× median	Above Median
13	1558677062	$220K	$13.39	1.7× median	Above Median
14	1801947668	$203K	$12.20	1.5× median	Above Median
15	1922368166	$178K	$16.95	2.1× median	Above 75th
16	1154338861	$163K	$2.22	0.3× median	Below Median
17	1679971097	$161K	$2.05	0.3× median	Below Median
18	1841550696	$152K	$4.07	0.5× median	Below Median
19	1477869089	$87K	$11.21	1.4× median	Above Median
20	1649786260	$75K	$73.18	9.2× median	Top 1%

Showing top 20 of 72 providers billing this code

Related Procedures

J0574$89.4M J0572$20.5M J0561$17.6M J0575$15.8M J0573$4.5M

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