J1626
HCPCS Procedure Code
HCPCS code J1626 is the #3,549 most-billed Medicaid procedure code, with $1.5M in payments across 131K claims from 2018–2024. The national median cost per claim is $2.63. Costs vary widely — the 90th percentile is $24.54 per claim, 9.3× the median.
Total Paid
$1.5M
0.00% of all spending
Total Claims
131K
Providers
126
Avg Cost/Claim
$12
National Cost Distribution
How much do providers bill per claim for J1626? Based on 112 providers billing this code nationally.
Median
$2.63
Average
$16.46
Std Dev
$77.54
Max
$801.95
Percentile Distribution (Cost per Claim)
50% of providers bill between $1.34 and $8.29 per claim for this code.
90% bill between $0.38 and $24.54.
Top 1% bill above $136.76.
About This Procedure
HCPCS code J1626 was billed by 126 providers across 131K claims, totaling $1.5M in Medicaid payments from 2018–2024. This code was used for 67K 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
$2.63
Providers Billing
112
National Spending
$1.5M
Avg/Median Ratio
6.26×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J1626
| # | Provider | Total Paid |
|---|---|---|
| 1 | Keck Medical Center Of Usc Los Angeles, CA · General Acute Care Hospital | $275K |
| 2 | 1679900567 | $213K |
| 3 | 1770728438 | $207K |
| 4 | 1396087672 | $165K |
| 5 | 1508147810 | $139K |
| 6 | 1871844522 | $75K |
| 7 | 1326124819 | $48K |
| 8 | The Cooper Health System Camden, NJ · General Acute Care Hospital | $42K |
| 9 | 1811991227 | $36K |
| 10 | 1255644357 | $32K |
| 11 | 1821271032 | $28K |
| 12 | 1093818551 | $24K |
| 13 | County Of Santa Clara San Jose, CA · Case Manager/Care Coordinator | $23K |
| 14 | 1467437848 | $23K |
| 15 | 1528399193 | $17K |
| 16 | Norton Hospitals Inc Louisville, KY · General Acute Care Hospital | $17K |
| 17 | 1548361413 | $15K |
| 18 | Maimonides Medical Center Brooklyn, NY · General Acute Care Hospital | $14K |
| 19 | 1417975061 | $10K |
| 20 | 1013981554 | $10K |
Showing top 20 of 126 providers billing this code