#4872 of 11K

J1071

HCPCS Procedure Code

HCPCS code J1071 is the #4,872 most-billed Medicaid procedure code, with $367K in payments across 122K claims from 2018–2024. The national median cost per claim is $2.43. Costs vary widely — the 90th percentile is $7.30 per claim, 3.0× the median.

Total Paid

$367K

0.00% of all spending

Total Claims

122K

Providers

175

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for J1071? Based on 151 providers billing this code nationally.

Median

$2.43

Average

$3.71

Std Dev

$6.55

Max

$56.32

Percentile Distribution (Cost per Claim)

p10

$0.06

p25

$0.71

Median

$2.43

p75

$3.96

p90

$7.30

p95

$10.94

p99

$36.57

50% of providers bill between $0.71 and $3.96 per claim for this code.

90% bill between $0.06 and $7.30.

Top 1% bill above $36.57.

About This Procedure

HCPCS code J1071 was billed by 175 providers across 122K claims, totaling $367K in Medicaid payments from 2018–2024. This code was used for 71K 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

$2.43

Providers Billing

151

National Spending

$367K

Avg/Median Ratio

1.53×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for J1071

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	University Of Utah Salt Lake City, UT · Clinic/Center, Dental	$43K	$45.47	18.7× median	Top 1%
2	1548305584	$30K	$3.50	1.4× median	Above Median
3	Umass Memorial Medical Center, Inc. Worcester, MA · General Acute Care Hospital	$23K	$15.22	6.3× median	Top 10%
4	1790798072	$20K	$3.54	1.5× median	Above Median
5	North Shore-lij Medical Pc Great Neck, NY · Urology	$16K	$13.19	5.4× median	Top 10%
6	1689979569	$15K	$4.39	1.8× median	Above 75th
7	1164696449	$15K	$5.43	2.2× median	Above 75th
8	1295720449	$13K	$13.65	5.6× median	Top 10%
9	1124148952	$11K	$3.34	1.4× median	Above Median
10	1083661607	$10K	$11.61	4.8× median	Top 10%
11	1275864449	$10K	$2.32	1.0× median	Below Median
12	1730553108	$9K	$3.45	1.4× median	Above Median
13	Spectrum Health Primary Care Partners Grand Rapids, MI · Psychologist, Clinical Child & Adolescent	$9K	$3.36	1.4× median	Above Median
14	1780112805	$8K	$3.79	1.6× median	Above Median
15	1710261615	$8K	$8.24	3.4× median	Top 10%
16	1104004183	$8K	$2.52	1.0× median	Above Median
17	1366618019	$7K	$3.38	1.4× median	Above Median
18	The Miriam Hospital Providence, RI · General Acute Care Hospital	$7K	$5.81	2.4× median	Above 75th
19	1538453923	$7K	$2.15	0.9× median	Below Median
20	1952417438	$6K	$0.56	0.2× median	Below Median

Showing top 20 of 175 providers billing this code

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