#548 of 11K

J1726

HCPCS Procedure Code

HCPCS code J1726 is the #548 most-billed Medicaid procedure code, with $151.5M in payments across 137K claims from 2018–2024. The national median cost per claim is $789.74. Costs vary widely — the 90th percentile is $2,807.31 per claim, 3.6× the median.

Total Paid

$151.5M

0.01% of all spending

Total Claims

137K

Providers

Avg Cost/Claim

$1K

National Cost Distribution

How much do providers bill per claim for J1726? Based on 65 providers billing this code nationally.

Median

$789.74

Average

$1,205.21

Std Dev

$1,003.09

Max

$3,233.51

Percentile Distribution (Cost per Claim)

p10

$79.39

p25

$387.20

Median

$789.74

p75

$2,108.67

p90

$2,807.31

p95

$2,887.16

p99

$3,071.14

50% of providers bill between $387.20 and $2,108.67 per claim for this code.

90% bill between $79.39 and $2,807.31.

Top 1% bill above $3,071.14.

About This Procedure

HCPCS code J1726 was billed by 70 providers across 137K claims, totaling $151.5M in Medicaid payments from 2018–2024. This code was used for 55K 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

$789.74

Providers Billing

National Spending

$151.5M

Avg/Median Ratio

1.53×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for J1726

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Optum Women's And Children's Health, Llc Marietta, GA · Home Health	$32.7M	$1,048.42	1.3× median	Above Median
2	1154418218	$20.6M	$744.36	0.9× median	Below Median
3	Procare Pharmacy Direct, Llc. Monroeville, PA · Pharmacy, Community/Retail Pharmacy	$18.6M	$2,871.26	3.6× median	Top 10%
4	1376631457	$9.9M	$1,200.60	1.5× median	Above Median
5	1518036458	$7.8M	$692.56	0.9× median	Below Median
6	1457381782	$6.3M	$823.73	1.0× median	Above Median
7	1083045140	$5.3M	$2,291.28	2.9× median	Above 75th
8	1679083109	$4.4M	$2,490.72	3.2× median	Above 75th
9	1518349562	$4.4M	$680.23	0.9× median	Below Median
10	1134100134	$3.8M	$2,251.25	2.9× median	Above 75th
11	1174693592	$3.6M	$2,953.72	3.7× median	Top 10%
12	1013942788	$3.4M	$1,327.19	1.7× median	Above Median
13	1295842615	$3.2M	$2,869.99	3.6× median	Top 10%
14	1942453220	$3.0M	$2,330.27	3.0× median	Above 75th
15	Accredo Health Group Inc Memphis, TN · Pharmacy	$2.6M	$2,000.20	2.5× median	Above Median
16	1366432122	$2.4M	$689.24	0.9× median	Below Median
17	1962514877	$1.9M	$2,979.81	3.8× median	Top 10%
18	1720364532	$1.7M	$2,588.82	3.3× median	Above 75th
19	1124009121	$1.4M	$2,891.14	3.7× median	Top 10%
20	1730227455	$1.3M	$1,756.18	2.2× median	Above Median

Showing top 20 of 70 providers billing this code

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