J1097
HCPCS Procedure Code
HCPCS code J1097 is the #4,167 most-billed Medicaid procedure code, with $791K in payments across 18K claims from 2018–2024. The national median cost per claim is $47.04. Costs vary widely — the 90th percentile is $165.70 per claim, 3.5× the median.
Total Paid
$791K
0.00% of all spending
Total Claims
18K
Providers
73
Avg Cost/Claim
$43
National Cost Distribution
How much do providers bill per claim for J1097? Based on 58 providers billing this code nationally.
Median
$47.04
Average
$65.12
Std Dev
$65.45
Max
$293.90
Percentile Distribution (Cost per Claim)
50% of providers bill between $15.91 and $91.75 per claim for this code.
90% bill between $5.11 and $165.70.
Top 1% bill above $246.03.
About This Procedure
HCPCS code J1097 was billed by 73 providers across 18K claims, totaling $791K in Medicaid payments from 2018–2024. This code was used for 12K 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
$47.04
Providers Billing
58
National Spending
$791K
Avg/Median Ratio
1.38×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J1097
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1619970472 | $133K |
| 2 | 1497951164 | $100K |
| 3 | 1639177751 | $90K |
| 4 | 1275594012 | $53K |
| 5 | 1235187972 | $52K |
| 6 | 1306119615 | $47K |
| 7 | 1447258603 | $35K |
| 8 | 1346698602 | $31K |
| 9 | 1750390548 | $19K |
| 10 | 1326004110 | $17K |
| 11 | 1346220183 | $16K |
| 12 | 1558853234 | $15K |
| 13 | 1215014022 | $15K |
| 14 | 1255604534 | $13K |
| 15 | 1720156482 | $12K |
| 16 | Mainegeneral Medical Center Augusta, ME · General Acute Care Hospital | $11K |
| 17 | 1376546721 | $10K |
| 18 | 1619969219 | $10K |
| 19 | 1649350844 | $9K |
| 20 | 1457350449 | $9K |
Showing top 20 of 73 providers billing this code