J1561
HCPCS Procedure Code
HCPCS code J1561 is the #684 most-billed Medicaid procedure code, with $106.2M in payments across 72K claims from 2018–2024. The national median cost per claim is $1,482.84. Costs vary widely — the 90th percentile is $3,739.16 per claim, 2.5× the median.
Total Paid
$106.2M
0.01% of all spending
Total Claims
72K
Providers
73
Avg Cost/Claim
$1K
National Cost Distribution
How much do providers bill per claim for J1561? Based on 73 providers billing this code nationally.
Median
$1,482.84
Average
$1,790.84
Std Dev
$1,613.24
Max
$7,492.15
Percentile Distribution (Cost per Claim)
50% of providers bill between $729.18 and $2,164.17 per claim for this code.
90% bill between $180.16 and $3,739.16.
Top 1% bill above $7,265.89.
About This Procedure
HCPCS code J1561 was billed by 73 providers across 72K claims, totaling $106.2M in Medicaid payments from 2018–2024. This code was used for 32K 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
$1,482.84
Providers Billing
73
National Spending
$106.2M
Avg/Median Ratio
1.21×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J1561
| # | Provider | Total Paid |
|---|---|---|
| 1 | Childrens Hospital Of Philadelphia Philadelphia, PA · General Acute Care Hospital Children | $10.2M |
| 2 | Children's Health System Of Texas Dallas, TX · General Acute Care Hospital Children | $7.7M |
| 3 | Children's Hospital Corporation Boston, MA · Clinic/Center | $7.6M |
| 4 | University Of Kentucky Lexington, KY · General Acute Care Hospital | $7.2M |
| 5 | University Of California Irvine Orange, CA · General Acute Care Hospital | $6.8M |
| 6 | 1265462659 | $6.5M |
| 7 | The New York And Presbyterian Hospital New York, NY · General Acute Care Hospital | $5.2M |
| 8 | Accredo Health Group Inc Warrendale, PA · Pharmacy, Community/Retail Pharmacy | $4.9M |
| 9 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $4.5M |
| 10 | Mount Sinai Hospital New York, NY · Ambulance | $4.0M |
| 11 | Hmh Hospitals Corporation Hackensack, NJ · Ambulance | $3.5M |
| 12 | Banner - University Medical Center Tucson Campus Llc Tucson, AZ · Clinic/Center, Multi-Specialty | $3.4M |
| 13 | Regents Of The University Of California San Diego, CA · General Acute Care Hospital | $3.1M |
| 14 | 1902803315 | $2.8M |
| 15 | 1437230034 | $2.7M |
| 16 | Optum Infusion Services 308 Llc Chandler, AZ · Pharmacy Home Infusion Therapy Pharmacy | $2.5M |
| 17 | Dana-farber Cancer Institute, Inc. Boston, MA · General Acute Care Hospital | $1.8M |
| 18 | 1568474716 | $1.8M |
| 19 | Presbyterian Healthcare Services Albuquerque, NM · Emergency Medicine | $1.6M |
| 20 | Regents Of The University Of California Sacramento, CA · General Acute Care Hospital | $1.4M |
Showing top 20 of 73 providers billing this code