#747 of 11K

J0574

HCPCS Procedure Code

HCPCS code J0574 is the #747 most-billed Medicaid procedure code, with $89.4M in payments across 4.7M claims from 2018–2024. The national median cost per claim is $15.76. Costs vary widely — the 90th percentile is $52.92 per claim, 3.4× the median.

Total Paid

$89.4M

0.01% of all spending

Total Claims

4.7M

Providers

200

Avg Cost/Claim

$19

National Cost Distribution

How much do providers bill per claim for J0574? Based on 187 providers billing this code nationally.

Median

$15.76

Average

$27.27

Std Dev

$39.58

Max

$259.51

Percentile Distribution (Cost per Claim)

p10

$4.53

p25

$10.80

Median

$15.76

p75

$25.97

p90

$52.92

p95

$86.24

p99

$226.51

50% of providers bill between $10.80 and $25.97 per claim for this code.

90% bill between $4.53 and $52.92.

Top 1% bill above $226.51.

About This Procedure

HCPCS code J0574 was billed by 200 providers across 4.7M claims, totaling $89.4M in Medicaid payments from 2018–2024. This code was used for 398K 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

$15.76

Providers Billing

187

National Spending

$89.4M

Avg/Median Ratio

1.73×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for J0574

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1801258736	$8.3M	$20.12	1.3× median	Above Median
2	1609998137	$6.3M	$47.50	3.0× median	Above 75th
3	1003368945	$4.8M	$17.33	1.1× median	Above Median
4	Sunrise Treatment Center, Llc Cincinnati, OH · Clinic/Center, Adult Mental Health	$3.2M	$15.76	1.0× median	Below Median
5	1437213865	$3.2M	$13.79	0.9× median	Below Median
6	1679926745	$2.4M	$12.40	0.8× median	Below Median
7	1558607481	$2.3M	$13.34	0.8× median	Below Median
8	1083102511	$2.2M	$18.02	1.1× median	Above Median
9	1679556559	$2.0M	$17.92	1.1× median	Above Median
10	1487059531	$1.8M	$14.38	0.9× median	Below Median
11	1134346687	$1.8M	$221.47	14.1× median	Top 10%
12	Brightview Llc Cincinnati, OH · Internal Medicine Addiction Medicine	$1.7M	$23.00	1.5× median	Above Median
13	1396001798	$1.6M	$16.62	1.1× median	Above Median
14	1609351477	$1.6M	$259.51	16.5× median	Top 1%
15	1568947497	$1.5M	$24.20	1.5× median	Above Median
16	1780165480	$1.5M	$29.42	1.9× median	Above 75th
17	1407115298	$1.4M	$17.69	1.1× median	Above Median
18	1811035520	$1.4M	$14.66	0.9× median	Below Median
19	1538630009	$1.4M	$35.63	2.3× median	Above 75th
20	1093108755	$1.3M	$14.49	0.9× median	Below Median

Showing top 20 of 200 providers billing this code

Related Procedures

J0584Burosumab-twza (Crysvita) injection, 1 mg$168.4M J0572$20.5M J0575$15.8M J0571$9.5M J0573$4.5M

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