Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

#4497 of 11K

J1201

HCPCS Procedure Code

HCPCS code J1201 is the #4,497 most-billed Medicaid procedure code, with $547K in payments across 638 claims from 2018–2024. The national median cost per claim is $857.49.

Total Paid

$547K

0.00% of all spending

Total Claims

638

Providers

1

Avg Cost/Claim

$857

National Cost Distribution

How much do providers bill per claim for J1201? Based on 1 providers billing this code nationally.

Median

$857.49

Average

$857.49

Std Dev

Max

$857.49

Percentile Distribution (Cost per Claim)

p10
$857.49
p25
$857.49
Median
$857.49
p75
$857.49
p90
$857.49
p95
$857.49
p99
$857.49

50% of providers bill between $857.49 and $857.49 per claim for this code.

90% bill between $857.49 and $857.49.

Top 1% bill above $857.49.

About This Procedure

HCPCS code J1201 was billed by 1 providers across 638 claims, totaling $547K in Medicaid payments from 2018–2024. This code was used for 382 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

$857.49

Providers Billing

1

National Spending

$547K

Avg/Median Ratio

1.00×

Normal distribution

Provider Coverage

We have 1 providers billing this code in our dataset. Individual provider breakdowns are available for top-spending procedure codes.

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