#1517 of 11K

J0572

HCPCS Procedure Code

HCPCS code J0572 is the #1,517 most-billed Medicaid procedure code, with $20.5M in payments across 1.8M claims from 2018–2024. The national median cost per claim is $8.49. Costs vary widely — the 90th percentile is $32.72 per claim, 3.9× the median.

Total Paid

$20.5M

0.00% of all spending

Total Claims

1.8M

Providers

124

Avg Cost/Claim

$11

National Cost Distribution

How much do providers bill per claim for J0572? Based on 118 providers billing this code nationally.

Median

$8.49

Average

$16.84

Std Dev

$29.72

Max

$238.15

Percentile Distribution (Cost per Claim)

p10

$3.60

p25

$6.04

Median

$8.49

p75

$12.99

p90

$32.72

p95

$73.02

p99

$130.06

50% of providers bill between $6.04 and $12.99 per claim for this code.

90% bill between $3.60 and $32.72.

Top 1% bill above $130.06.

About This Procedure

HCPCS code J0572 was billed by 124 providers across 1.8M claims, totaling $20.5M in Medicaid payments from 2018–2024. This code was used for 154K 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

$8.49

Providers Billing

118

National Spending

$20.5M

Avg/Median Ratio

1.98×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for J0572

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1154722361	$2.5M	$136.13	16.0× median	Top 1%
2	1801258736	$2.3M	$12.98	1.5× median	Above Median
3	1003368945	$1.7M	$11.61	1.4× median	Above Median
4	1437213865	$865K	$8.16	1.0× median	Below Median
5	1679926745	$705K	$9.36	1.1× median	Above Median
6	1598021917	$681K	$8.70	1.0× median	Above Median
7	1538208566	$632K	$8.33	1.0× median	Below Median
8	Sunrise Treatment Center, Llc Cincinnati, OH · Clinic/Center, Adult Mental Health	$596K	$11.16	1.3× median	Above Median
9	1083102511	$586K	$11.97	1.4× median	Above Median
10	1487059531	$582K	$8.42	1.0× median	Below Median
11	Brightview Llc Cincinnati, OH · Internal Medicine Addiction Medicine	$533K	$20.45	2.4× median	Above 75th
12	1396001798	$475K	$9.13	1.1× median	Above Median
13	1609998137	$370K	$7.96	0.9× median	Below Median
14	1568947497	$361K	$8.96	1.1× median	Above Median
15	1679556559	$353K	$10.57	1.2× median	Above Median
16	1134346687	$346K	$87.25	10.3× median	Top 10%
17	1386783314	$325K	$7.81	0.9× median	Below Median
18	1811035520	$310K	$6.98	0.8× median	Below Median
19	1093108755	$305K	$7.59	0.9× median	Below Median
20	1649786260	$287K	$51.31	6.0× median	Top 10%

Showing top 20 of 124 providers billing this code

Related Procedures

J0574$89.4M J0575$15.8M J0571$9.5M J0573$4.5M J0578$2.6M

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