J1555
HCPCS Procedure Code
HCPCS code J1555 is the #2,559 most-billed Medicaid procedure code, with $5.0M in payments across 3K claims from 2018–2024. The national median cost per claim is $1,277.71.
Total Paid
$5.0M
0.00% of all spending
Total Claims
3K
Providers
6
Avg Cost/Claim
$2K
National Cost Distribution
How much do providers bill per claim for J1555? Based on 6 providers billing this code nationally.
Median
$1,277.71
Average
$1,374.49
Std Dev
$459.41
Max
$1,917.24
Percentile Distribution (Cost per Claim)
50% of providers bill between $984.84 and $1,782.13 per claim for this code.
90% bill between $960.38 and $1,885.39.
Top 1% bill above $1,914.05.
About This Procedure
HCPCS code J1555 was billed by 6 providers across 3K claims, totaling $5.0M in Medicaid payments from 2018–2024. This code was used for 2K 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
$1,277.71
Providers Billing
6
National Spending
$5.0M
Avg/Median Ratio
1.08×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J1555
| # | Provider | Total Paid |
|---|---|---|
| 1 | Accredo Health Group Inc Warrendale, PA · Pharmacy, Community/Retail Pharmacy | $4.2M |
| 2 | 1952598575 | $415K |
| 3 | 1346673126 | $211K |
| 4 | 1932412095 | $90K |
| 5 | 1851337778 | $45K |
| 6 | 1114973716 | $30K |
Showing top 6 of 6 providers billing this code