#971 of 11K

J1559

HCPCS Procedure Code

HCPCS code J1559 is the #971 most-billed Medicaid procedure code, with $52.5M in payments across 45K claims from 2018–2024. The national median cost per claim is $811.35. Costs vary widely — the 90th percentile is $2,044.78 per claim, 2.5× the median.

Total Paid

$52.5M

0.00% of all spending

Total Claims

45K

Providers

Avg Cost/Claim

$1K

National Cost Distribution

How much do providers bill per claim for J1559? Based on 32 providers billing this code nationally.

Median

$811.35

Average

$1,044.79

Std Dev

$861.64

Max

$4,452.17

Percentile Distribution (Cost per Claim)

p10

$273.31

p25

$489.33

Median

$811.35

p75

$1,367.19

p90

$2,044.78

p95

$2,311.52

p99

$3,834.23

50% of providers bill between $489.33 and $1,367.19 per claim for this code.

90% bill between $273.31 and $2,044.78.

Top 1% bill above $3,834.23.

About This Procedure

HCPCS code J1559 was billed by 32 providers across 45K claims, totaling $52.5M in Medicaid payments from 2018–2024. This code was used for 18K 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

$811.35

Providers Billing

National Spending

$52.5M

Avg/Median Ratio

1.29×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J1559

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Accredo Health Group Inc Warrendale, PA · Pharmacy, Community/Retail Pharmacy	$12.4M	$1,335.72	1.6× median	Above Median
2	1710057500	$9.7M	$4,452.17	5.5× median	Top 1%
3	1932266632	$4.9M	$1,497.92	1.8× median	Above 75th
4	1477647337	$4.7M	$729.34	0.9× median	Below Median
5	1851337778	$4.6M	$1,222.78	1.5× median	Above Median
6	1326096629	$2.9M	$904.24	1.1× median	Above Median
7	1184653388	$2.4M	$746.49	0.9× median	Below Median
8	1346250610	$2.0M	$1,038.60	1.3× median	Above Median
9	1366603854	$1.6M	$698.13	0.9× median	Below Median
10	Optum Infusion Services 308 Llc Chandler, AZ · Pharmacy Home Infusion Therapy Pharmacy	$1.5M	$730.98	0.9× median	Below Median
11	1932412095	$1.1M	$999.32	1.2× median	Above Median
12	1134100134	$959K	$2,458.82	3.0× median	Top 10%
13	1245564012	$695K	$564.52	0.7× median	Below Median
14	1528345519	$598K	$1,056.75	1.3× median	Above Median
15	1952440604	$391K	$870.20	1.1× median	Above Median
16	1508890450	$332K	$1,461.60	1.8× median	Above 75th
17	1821043027	$270K	$295.63	0.4× median	Below Median
18	1952598575	$243K	$2,191.00	2.7× median	Top 10%
19	1114973716	$236K	$243.25	0.3× median	Below Median
20	1386674067	$235K	$1,578.37	1.9× median	Above 75th

Showing top 20 of 32 providers billing this code

Related Procedures

J1569$127.7M J1561$106.2M J1568Injection, immune globulin (OCTAGAM), intravenous, non-lyophilized$11.0M J1555$5.0M J1557$873K

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