J1580
HCPCS Procedure Code
HCPCS code J1580 is the #4,998 most-billed Medicaid procedure code, with $324K in payments across 91K claims from 2018–2024. The national median cost per claim is $1.13. Costs vary widely — the 90th percentile is $7.66 per claim, 6.8× the median.
Total Paid
$324K
0.00% of all spending
Total Claims
91K
Providers
324
Avg Cost/Claim
$4
National Cost Distribution
How much do providers bill per claim for J1580? Based on 215 providers billing this code nationally.
Median
$1.13
Average
$5.61
Std Dev
$22.71
Max
$270.59
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.37 and $2.99 per claim for this code.
90% bill between $0.10 and $7.66.
Top 1% bill above $92.15.
About This Procedure
HCPCS code J1580 was billed by 324 providers across 91K claims, totaling $324K in Medicaid payments from 2018–2024. This code was used for 74K 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
$1.13
Providers Billing
215
National Spending
$324K
Avg/Median Ratio
4.96×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J1580
| # | Provider | Total Paid |
|---|---|---|
| 1 | Charleston Area Medical Center Inc Charleston, WV · General Acute Care Hospital | $45K |
| 2 | 1184606600 | $24K |
| 3 | 1518036458 | $22K |
| 4 | Seventh-day Adventists Loma Linda University Medical Center Loma Linda, CA · General Acute Care Hospital | $16K |
| 5 | 1417976705 | $15K |
| 6 | 1326096629 | $13K |
| 7 | 1477584993 | $13K |
| 8 | 1932266632 | $13K |
| 9 | Pikeville Medical Center Inc Pikeville, KY · General Acute Care Hospital | $11K |
| 10 | 1629116645 | $10K |
| 11 | 1750332565 | $9K |
| 12 | Boston Medical Center Corporation Boston, MA · General Acute Care Hospital | $9K |
| 13 | 1376631457 | $7K |
| 14 | University Of Kentucky Lexington, KY · General Acute Care Hospital | $7K |
| 15 | Baptist Healthcare System Inc Corbin, KY · General Acute Care Hospital | $6K |
| 16 | Unm Hospital Albuquerque, NM · General Acute Care Hospital | $6K |
| 17 | 1619038247 | $6K |
| 18 | 1316935851 | $6K |
| 19 | 1750317079 | $5K |
| 20 | 1811213994 | $5K |
Showing top 20 of 324 providers billing this code