J0586
HCPCS Procedure Code
HCPCS code J0586 is the #1,775 most-billed Medicaid procedure code, with $14.2M in payments across 29K claims from 2018–2024. The national median cost per claim is $667.48. Costs vary widely — the 90th percentile is $1,535.47 per claim, 2.3× the median.
Total Paid
$14.2M
0.00% of all spending
Total Claims
29K
Providers
42
Avg Cost/Claim
$497
National Cost Distribution
How much do providers bill per claim for J0586? Based on 35 providers billing this code nationally.
Median
$667.48
Average
$764.40
Std Dev
$512.32
Max
$2,020.36
Percentile Distribution (Cost per Claim)
50% of providers bill between $385.78 and $1,022.79 per claim for this code.
90% bill between $195.87 and $1,535.47.
Top 1% bill above $1,965.71.
About This Procedure
HCPCS code J0586 was billed by 42 providers across 29K claims, totaling $14.2M in Medicaid payments from 2018–2024. This code was used for 19K 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
$667.48
Providers Billing
35
National Spending
$14.2M
Avg/Median Ratio
1.15×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J0586
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1629356431 | $3.0M |
| 2 | Scottish Rite Children's Medical Center Atlanta, GA · Pediatrics Pediatric Hematology-Oncology | $1.7M |
| 3 | 1346246931 | $1.5M |
| 4 | 1639134414 | $1.2M |
| 5 | Egleston Children's Hospital At Emory University Inc. Atlanta, GA · Pediatrics Pediatric Emergency Medicine | $922K |
| 6 | 1700949336 | $849K |
| 7 | 1508804105 | $779K |
| 8 | 1982859187 | $698K |
| 9 | 1629203294 | $638K |
| 10 | 1982793139 | $517K |
| 11 | Phoenix Children's Hospital Phoenix, AZ · General Acute Care Hospital Children | $444K |
| 12 | 1710098306 | $300K |
| 13 | 1376075804 | $230K |
| 14 | 1669579785 | $207K |
| 15 | 1003029455 | $182K |
| 16 | 1477596583 | $180K |
| 17 | Loma Linda University Children's Hospital Loma Linda, CA · General Acute Care Hospital Children | $161K |
| 18 | 1518918358 | $129K |
| 19 | The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital | $121K |
| 20 | Froedtert Memorial Lutheran Hospital, Inc. Milwaukee, WI · Clinic/Center, Radiology | $66K |
Showing top 20 of 42 providers billing this code