#2625 of 11K

J0573

HCPCS Procedure Code

HCPCS code J0573 is the #2,625 most-billed Medicaid procedure code, with $4.5M in payments across 325K claims from 2018–2024. The national median cost per claim is $12.82.

Total Paid

$4.5M

0.00% of all spending

Total Claims

325K

Providers

Avg Cost/Claim

$14

National Cost Distribution

How much do providers bill per claim for J0573? Based on 59 providers billing this code nationally.

Median

$12.82

Average

$15.06

Std Dev

$11.60

Max

$70.24

Percentile Distribution (Cost per Claim)

p10

$4.89

p25

$9.16

Median

$12.82

p75

$15.73

p90

$22.27

p95

$44.16

p99

$56.50

50% of providers bill between $9.16 and $15.73 per claim for this code.

90% bill between $4.89 and $22.27.

Top 1% bill above $56.50.

About This Procedure

HCPCS code J0573 was billed by 60 providers across 325K claims, totaling $4.5M in Medicaid payments from 2018–2024. This code was used for 22K 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

$12.82

Providers Billing

National Spending

$4.5M

Avg/Median Ratio

1.17×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J0573

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1598021917	$611K	$15.19	1.2× median	Above Median
2	1689937260	$478K	$18.40	1.4× median	Above 75th
3	1154338861	$366K	$12.82	1.0× median	Above Median
4	1922206325	$321K	$19.87	1.6× median	Above 75th
5	1609998137	$234K	$14.79	1.2× median	Above Median
6	1801258736	$214K	$21.64	1.7× median	Above 75th
7	1669411377	$198K	$7.26	0.6× median	Below Median
8	1679926745	$196K	$13.78	1.1× median	Above Median
9	1487059531	$196K	$13.47	1.1× median	Above Median
10	1467416206	$181K	$46.55	3.6× median	Top 10%
11	1497818595	$173K	$10.31	0.8× median	Below Median
12	1093071920	$114K	$13.76	1.1× median	Above Median
13	1225115439	$113K	$13.25	1.0× median	Above Median
14	1528325420	$99K	$12.57	1.0× median	Below Median
15	1902944002	$89K	$8.62	0.7× median	Below Median
16	1689677783	$87K	$24.11	1.9× median	Top 10%
17	1811035520	$81K	$11.22	0.9× median	Below Median
18	1447567755	$75K	$20.62	1.6× median	Above 75th
19	1336103241	$74K	$23.03	1.8× median	Top 10%
20	1780165480	$68K	$9.67	0.8× median	Below Median

Showing top 20 of 60 providers billing this code

Related Procedures

J0574$89.4M J0572$20.5M J0575$15.8M J0571$9.5M J0578$2.6M

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