J1596
HCPCS Procedure Code
HCPCS code J1596 is the #5,703 most-billed Medicaid procedure code, with $151K in payments across 157K claims from 2018–2024. The national median cost per claim is $0.42. Costs vary widely — the 90th percentile is $6.56 per claim, 15.6× the median.
Total Paid
$151K
0.00% of all spending
Total Claims
157K
Providers
630
Avg Cost/Claim
$1
National Cost Distribution
How much do providers bill per claim for J1596? Based on 284 providers billing this code nationally.
Median
$0.42
Average
$2.73
Std Dev
$8.64
Max
$122.34
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.05 and $2.05 per claim for this code.
90% bill between $0.01 and $6.56.
Top 1% bill above $26.91.
About This Procedure
HCPCS code J1596 was billed by 630 providers across 157K claims, totaling $151K in Medicaid payments from 2018–2024. This code was used for 139K 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
$0.42
Providers Billing
284
National Spending
$151K
Avg/Median Ratio
6.50×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J1596
| # | Provider | Total Paid |
|---|---|---|
| 1 | Norton Hospitals, Inc Louisville, KY · General Acute Care Hospital | $22K |
| 2 | 1104856095 | $17K |
| 3 | Uofl Health-louisville Inc Louisville, KY · Psychiatric Hospital | $10K |
| 4 | Scottish Rite Children's Medical Center Atlanta, GA · Pediatrics Pediatric Hematology-Oncology | $5K |
| 5 | 1811213994 | $5K |
| 6 | 1770581894 | $4K |
| 7 | Vanderbilt University Medical Center Nashville, TN · Psychiatric Unit | $4K |
| 8 | Dignity Health San Bernardino, CA · General Acute Care Hospital | $3K |
| 9 | 1447221742 | $3K |
| 10 | 1134194038 | $3K |
| 11 | 1477671535 | $3K |
| 12 | Owensboro Health Inc Owensboro, KY · General Acute Care Hospital | $3K |
| 13 | 1609858950 | $2K |
| 14 | 1205882503 | $2K |
| 15 | 1447457775 | $2K |
| 16 | 1891892741 | $2K |
| 17 | Pikeville Medical Center Inc Pikeville, KY · General Acute Care Hospital | $2K |
| 18 | 1982799375 | $2K |
| 19 | 1003985755 | $2K |
| 20 | 1679679146 | $2K |
Showing top 20 of 630 providers billing this code