#1707 of 11K

J0575

HCPCS Procedure Code

HCPCS code J0575 is the #1,707 most-billed Medicaid procedure code, with $15.8M in payments across 575K claims from 2018–2024. The national median cost per claim is $14.96. Costs vary widely — the 90th percentile is $59.35 per claim, 4.0× the median.

Total Paid

$15.8M

0.00% of all spending

Total Claims

575K

Providers

Avg Cost/Claim

$27

National Cost Distribution

How much do providers bill per claim for J0575? Based on 47 providers billing this code nationally.

Median

$14.96

Average

$32.10

Std Dev

$59.04

Max

$316.42

Percentile Distribution (Cost per Claim)

p10

$3.45

p25

$8.66

Median

$14.96

p75

$20.82

p90

$59.35

p95

$129.90

p99

$280.68

50% of providers bill between $8.66 and $20.82 per claim for this code.

90% bill between $3.45 and $59.35.

Top 1% bill above $280.68.

About This Procedure

HCPCS code J0575 was billed by 52 providers across 575K claims, totaling $15.8M in Medicaid payments from 2018–2024. This code was used for 52K 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

$14.96

Providers Billing

National Spending

$15.8M

Avg/Median Ratio

2.15×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for J0575

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1609998137	$6.7M	$63.74	4.3× median	Top 10%
2	1134346687	$1.7M	$316.42	21.2× median	Top 1%
3	1902944002	$1.1M	$19.48	1.3× median	Above Median
4	1922368166	$1.0M	$118.81	7.9× median	Top 10%
5	1669411377	$698K	$12.82	0.9× median	Below Median
6	1467416206	$674K	$134.65	9.0× median	Top 10%
7	1558607481	$613K	$9.74	0.7× median	Below Median
8	1225115439	$607K	$24.01	1.6× median	Above 75th
9	1689733792	$554K	$5.91	0.4× median	Below Median
10	1083141600	$345K	$26.35	1.8× median	Above 75th
11	1730185232	$325K	$238.72	16.0× median	Top 10%
12	1578685822	$240K	$35.83	2.4× median	Above 75th
13	1023686284	$214K	$6.99	0.5× median	Below Median
14	Sunrise Treatment Center, Llc Cincinnati, OH · Clinic/Center, Adult Mental Health	$180K	$9.90	0.7× median	Below Median
15	1881957587	$111K	$19.09	1.3× median	Above Median
16	1437213865	$101K	$17.48	1.2× median	Above Median
17	1649631086	$95K	$3.34	0.2× median	Below Median
18	1245635549	$86K	$13.25	0.9× median	Below Median
19	1174666358	$78K	$18.61	1.2× median	Above Median
20	Habit Opco, Llc Springfield, MA · Case Management	$36K	$10.53	0.7× median	Below Median

Showing top 20 of 52 providers billing this code

Related Procedures

J0585Injection, onabotulinumtoxinA, 1 unit$506.8M J0584Burosumab-twza (Crysvita) injection, 1 mg$168.4M J0574$89.4M J0572$20.5M J0571$9.5M

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