J0578
HCPCS Procedure Code
HCPCS code J0578 is the #3,078 most-billed Medicaid procedure code, with $2.6M in payments across 2K claims from 2018–2024. The national median cost per claim is $1,710.92.
Total Paid
$2.6M
0.00% of all spending
Total Claims
2K
Providers
18
Avg Cost/Claim
$1K
National Cost Distribution
How much do providers bill per claim for J0578? Based on 11 providers billing this code nationally.
Median
$1,710.92
Average
$1,848.18
Std Dev
$1,610.05
Max
$6,413.93
Percentile Distribution (Cost per Claim)
50% of providers bill between $1,327.24 and $1,742.16 per claim for this code.
90% bill between $925.81 and $1,747.86.
Top 1% bill above $5,947.33.
About This Procedure
HCPCS code J0578 was billed by 18 providers across 2K claims, totaling $2.6M in Medicaid payments from 2018–2024. This code was used for 2K 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
$1,710.92
Providers Billing
11
National Spending
$2.6M
Avg/Median Ratio
1.08×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J0578
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1063587046 | $744K |
| 2 | 1942453220 | $631K |
| 3 | Procare Pharmacy Direct, Llc. Monroeville, PA · Pharmacy, Community/Retail Pharmacy | $323K |
| 4 | 1801495544 | $322K |
| 5 | 1083659502 | $178K |
| 6 | 1881680718 | $154K |
| 7 | 1396280962 | $105K |
| 8 | 1699008649 | $73K |
| 9 | 1811413453 | $24K |
| 10 | 1497776454 | $23K |
| 11 | 1295450294 | $0 |
| 12 | 1477206886 | $0 |
| 13 | Sunrise Treatment Center, Llc Cincinnati, OH · Clinic/Center, Adult Mental Health | $0 |
| 14 | 1447297379 | $0 |
| 15 | 1588260889 | $0 |
| 16 | 1023054376 | $0 |
| 17 | 1467490425 | $0 |
| 18 | 1841240561 | $0 |
Showing top 18 of 18 providers billing this code