J0584
Burosumab-twza (Crysvita) injection, 1 mg
Burosumab-twza (Crysvita) injection, 1 mg is the #521 most-billed Medicaid procedure code, with $168.4M in payments across 11K claims from 2018–2024. The national median cost per claim is $15,993.89.
Total Paid
$168.4M
0.02% of all spending
Total Claims
11K
Providers
7
Avg Cost/Claim
$16K
National Cost Distribution
How much do providers bill per claim for J0584? Based on 7 providers billing this code nationally.
Median
$15,993.89
Average
$15,532.14
Std Dev
$3,749.09
Max
$20,524.13
Percentile Distribution (Cost per Claim)
50% of providers bill between $12,500.31 and $18,257.80 per claim for this code.
90% bill between $11,553.83 and $19,799.83.
Top 1% bill above $20,451.70.
About This Procedure
HCPCS code J0584 (Burosumab-twza (Crysvita) injection, 1 mg) was billed by 7 providers across 11K claims, totaling $168.4M in Medicaid payments from 2018–2024. This code was used for 6K 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
$15,993.89
Providers Billing
7
National Spending
$168.4M
Avg/Median Ratio
0.97×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J0584
| # | Provider | Total Paid |
|---|---|---|
| 1 | Procare Pharmacy Direct, Llc. Monroeville, PA · Pharmacy, Community/Retail Pharmacy | $72.4M |
| 2 | 1316213531 | $57.4M |
| 3 | 1659762524 | $17.5M |
| 4 | Orsini Pharmaceutical Services Llc Elk Grove Village, IL · Pharmacy Specialty Pharmacy | $9.9M |
| 5 | Pantherx Specialty Llc Coraopolis, PA · Pharmacy | $7.7M |
| 6 | Accredo Health Group Inc Memphis, TN · Pharmacy | $3.1M |
| 7 | Accredo Health Group Inc Irving, TX · Pharmacy | $342K |
Showing top 7 of 7 providers billing this code