Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

#8817 of 11K

J1598

HCPCS Procedure Code

HCPCS code J1598 is the #8,817 most-billed Medicaid procedure code, with $1K in payments across 2,210 claims from 2018–2024. The national median cost per claim is $0.12. Costs vary widely — the 90th percentile is $3.91 per claim, 32.6× the median.

Total Paid

$1K

0.00% of all spending

Total Claims

2,210

Providers

23

Avg Cost/Claim

$0

National Cost Distribution

How much do providers bill per claim for J1598? Based on 7 providers billing this code nationally.

Median

$0.12

Average

$1.32

Std Dev

$2.05

Max

$5.31

Percentile Distribution (Cost per Claim)

p10
$0.05
p25
$0.09
Median
$0.12
p75
$1.79
p90
$3.91
p95
$4.61
p99
$5.17

50% of providers bill between $0.09 and $1.79 per claim for this code.

90% bill between $0.05 and $3.91.

Top 1% bill above $5.17.

About This Procedure

HCPCS code J1598 was billed by 23 providers across 2,210 claims, totaling $1K in Medicaid payments from 2018–2024. This code was used for 1,981 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

$0.12

Providers Billing

7

National Spending

$1K

Avg/Median Ratio

11.00×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for J1598

#ProviderTotal Paid
11992701429$663
21437150984$235
3Mary Imogene Bassett Hospital

Cooperstown, NY · General Acute Care Hospital, Rural

$137
4Summa Health System

Akron, OH · General Acute Care Hospital

$11
5St Lukes Roosevelt Hospital Center

New York, NY · Case Management

$8
6Mount Sinai Hospital

New York, NY · Ambulance

$6
7Beth Israel Medical Center

Brooklyn, NY · Psychiatric Unit

$6
81689628232$0
91851361778$0
101689672693$0
11Virginia Commonwealth University Health System Authority

Richmond, VA · General Acute Care Hospital

$0
121962464016$0
131134333206$0
141285715144$0
151245248939$0
161518912609$0
171487868097$0
181326043548$0
191154373843$0
201093713091$0

Showing top 20 of 23 providers billing this code