J1597
HCPCS Procedure Code
HCPCS code J1597 is the #9,143 most-billed Medicaid procedure code, with $301 in payments across 1,665 claims from 2018–2024. The national median cost per claim is $0.36. Costs vary widely — the 90th percentile is $1.94 per claim, 5.4× the median.
Total Paid
$301
0.00% of all spending
Total Claims
1,665
Providers
21
Avg Cost/Claim
$0
National Cost Distribution
How much do providers bill per claim for J1597? Based on 6 providers billing this code nationally.
Median
$0.36
Average
$0.83
Std Dev
$1.09
Max
$3.00
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.22 and $0.79 per claim for this code.
90% bill between $0.19 and $1.94.
Top 1% bill above $2.89.
About This Procedure
HCPCS code J1597 was billed by 21 providers across 1,665 claims, totaling $301 in Medicaid payments from 2018–2024. This code was used for 1,594 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
$0.36
Providers Billing
6
National Spending
$301
Avg/Median Ratio
2.31×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J1597
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1447231956 | $114 |
| 2 | Children's Hospital Medical Center Cincinnati, OH · Clinic/Center, Primary Care | $85 |
| 3 | 1568452290 | $30 |
| 4 | Nyu Langone Hospitals New York, NY · Clinic/Center, Oncology | $28 |
| 5 | Nationwide Children's Hospital Columbus, OH · General Acute Care Hospital | $26 |
| 6 | 1326485749 | $18 |
| 7 | 1821198755 | $0 |
| 8 | 1528197720 | $0 |
| 9 | 1578568481 | $0 |
| 10 | Nyu Langone Hospitals Brooklyn, NY · General Acute Care Hospital | $0 |
| 11 | Ochsner Clinic Foundation New Orleans, LA · General Acute Care Hospital | $0 |
| 12 | 1427536325 | $0 |
| 13 | 1235215427 | $0 |
| 14 | 1366444507 | $0 |
| 15 | Oregon Health & Science University Portland, OR · General Practice | $0 |
| 16 | 1861545683 | $0 |
| 17 | Swedish Health Services Seattle, WA · General Acute Care Hospital | $0 |
| 18 | 1598717480 | $0 |
| 19 | 1033107214 | $0 |
| 20 | 1447221056 | $0 |
Showing top 20 of 21 providers billing this code