#1540 of 11K

J1602

HCPCS Procedure Code

HCPCS code J1602 is the #1,540 most-billed Medicaid procedure code, with $19.8M in payments across 19K claims from 2018–2024. The national median cost per claim is $1,204.70.

Total Paid

$19.8M

0.00% of all spending

Total Claims

19K

Providers

Avg Cost/Claim

$1K

National Cost Distribution

How much do providers bill per claim for J1602? Based on 32 providers billing this code nationally.

Median

$1,204.70

Average

$1,073.57

Std Dev

$596.77

Max

$2,117.77

Percentile Distribution (Cost per Claim)

p10

$181.95

p25

$605.44

Median

$1,204.70

p75

$1,451.00

p90

$1,876.81

p95

$1,923.76

p99

$2,062.34

50% of providers bill between $605.44 and $1,451.00 per claim for this code.

90% bill between $181.95 and $1,876.81.

Top 1% bill above $2,062.34.

About This Procedure

HCPCS code J1602 was billed by 32 providers across 19K claims, totaling $19.8M in Medicaid payments from 2018–2024. This code was used for 12K 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

$1,204.70

Providers Billing

National Spending

$19.8M

Avg/Median Ratio

0.89×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J1602

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Arthritis & Rheumatology Associates Of South Jersey Pc Vineland, NJ · Internal Medicine Rheumatology	$7.1M	$1,396.60	1.2× median	Above Median
2	1174822902	$2.3M	$682.85	0.6× median	Below Median
3	1821602194	$1.6M	$1,439.02	1.2× median	Above Median
4	1700056280	$1.3M	$976.33	0.8× median	Below Median
5	1528036019	$1.0M	$1,240.16	1.0× median	Above Median
6	1659865962	$963K	$1,837.42	1.5× median	Above 75th
7	1275984700	$912K	$1,346.90	1.1× median	Above Median
8	1366489254	$865K	$1,486.95	1.2× median	Above 75th
9	1548717580	$606K	$1,911.33	1.6× median	Top 10%
10	1841246568	$567K	$630.50	0.5× median	Below Median
11	1891930673	$421K	$1,938.95	1.6× median	Top 10%
12	1245275981	$332K	$2,117.77	1.8× median	Top 1%
13	1891729141	$295K	$484.95	0.4× median	Below Median
14	1265783948	$265K	$1,091.01	0.9× median	Below Median
15	1356651566	$234K	$658.10	0.5× median	Below Median
16	1073999520	$192K	$161.83	0.1× median	Below Median
17	Kadlec Regional Medical Center Richland, WA · General Acute Care Hospital	$134K	$464.19	0.4× median	Below Median
18	1710107016	$104K	$839.36	0.7× median	Below Median
19	1073932554	$86K	$1,860.38	1.5× median	Above 75th
20	State Of Mississippi - University Of Mississippi Medical Center Jackson, MS · General Acute Care Hospital	$84K	$1,266.57	1.1× median	Above Median

Showing top 20 of 32 providers billing this code

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J1599$12.1M J1610$1.2M J1596$151K J1611$66K J1598$1K

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