#1950 of 11K

J1568

Injection, immune globulin (OCTAGAM), intravenous, non-lyophilized

Injection, immune globulin (OCTAGAM), intravenous, non-lyophilized is the #1,950 most-billed Medicaid procedure code, with $11.0M in payments across 6K claims from 2018–2024. The national median cost per claim is $1,911.51.

Total Paid

$11.0M

0.00% of all spending

Total Claims

Providers

Avg Cost/Claim

$2K

National Cost Distribution

How much do providers bill per claim for J1568? Based on 15 providers billing this code nationally.

Median

$1,911.51

Average

$2,015.40

Std Dev

$1,391.94

Max

$5,938.73

Percentile Distribution (Cost per Claim)

p10

$549.78

p25

$1,262.39

Median

$1,911.51

p75

$2,497.12

p90

$3,084.60

p95

$3,948.93

p99

$5,540.77

50% of providers bill between $1,262.39 and $2,497.12 per claim for this code.

90% bill between $549.78 and $3,084.60.

Top 1% bill above $5,540.77.

About This Procedure

HCPCS code J1568 (Injection, immune globulin (OCTAGAM), intravenous, non-lyophilized) was billed by 15 providers across 6K claims, totaling $11.0M 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

$1,911.51

Providers Billing

National Spending

$11.0M

Avg/Median Ratio

1.05×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J1568

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1265462659	$2.4M	$1,630.96	0.9× median	Below Median
2	1619952595	$2.3M	$5,938.73	3.1× median	Top 1%
3	Riverside University Health Systems - Medical Center Moreno Valley, CA · General Acute Care Hospital	$2.2M	$1,989.64	1.0× median	Above Median
4	1225600398	$2.0M	$1,409.41	0.7× median	Below Median
5	1013292689	$807K	$3,067.27	1.6× median	Above 75th
6	1326260498	$553K	$1,625.65	0.9× median	Below Median
7	Banner - University Medical Center Tucson Campus Llc Tucson, AZ · Clinic/Center, Multi-Specialty	$310K	$1,911.51	1.0× median	Below Median
8	1134718414	$164K	$2,726.35	1.4× median	Above 75th
9	1093112336	$90K	$3,096.15	1.6× median	Top 10%
10	1457409674	$79K	$207.36	0.1× median	Below Median
11	1225033020	$71K	$331.38	0.2× median	Below Median
12	1356307581	$61K	$2,035.91	1.1× median	Above Median
13	1457417933	$36K	$2,267.89	1.2× median	Above Median
14	1790706992	$36K	$877.38	0.5× median	Below Median
15	1811080526	$31K	$1,115.37	0.6× median	Below Median

Showing top 15 of 15 providers billing this code

Related Procedures

J1569$127.7M J1561$106.2M J1559$52.5M J1575$3.0M J1566$54K

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