#5484 of 11K

J1956

HCPCS Procedure Code

HCPCS code J1956 is the #5,484 most-billed Medicaid procedure code, with $189K in payments across 57K claims from 2018–2024. The national median cost per claim is $1.86. Costs vary widely — the 90th percentile is $18.29 per claim, 9.8× the median.

Total Paid

$189K

0.00% of all spending

Total Claims

57K

Providers

255

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for J1956? Based on 160 providers billing this code nationally.

Median

$1.86

Average

$12.68

Std Dev

$54.13

Max

$588.57

Percentile Distribution (Cost per Claim)

p10

$0.03

p25

$0.13

Median

$1.86

p75

$6.50

p90

$18.29

p95

$34.90

p99

$207.54

50% of providers bill between $0.13 and $6.50 per claim for this code.

90% bill between $0.03 and $18.29.

Top 1% bill above $207.54.

About This Procedure

HCPCS code J1956 was billed by 255 providers across 57K claims, totaling $189K in Medicaid payments from 2018–2024. This code was used for 40K 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

$1.86

Providers Billing

160

National Spending

$189K

Avg/Median Ratio

6.82×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for J1956

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Pikeville Medical Center Inc Pikeville, KY · General Acute Care Hospital	$20K	$18.76	10.1× median	Top 10%
2	1750332565	$18K	$34.84	18.7× median	Top 10%
3	Bluefield Hospital Company Llc Bluefield, WV · General Acute Care Hospital	$16K	$74.74	40.2× median	Top 10%
4	1306842521	$12K	$6.62	3.6× median	Above 75th
5	Uofl Health-louisville Inc Louisville, KY · Psychiatric Hospital	$11K	$10.86	5.8× median	Above 75th
6	1235183328	$10K	$301.90	162.3× median	Top 1%
7	1699704254	$9K	$588.57	316.4× median	Top 1%
8	1568461440	$8K	$69.76	37.5× median	Top 10%
9	1477584993	$7K	$141.97	76.3× median	Top 10%
10	1235139312	$7K	$26.60	14.3× median	Top 10%
11	1689761942	$5K	$4.65	2.5× median	Above Median
12	1609869916	$4K	$5.70	3.1× median	Above Median
13	Norton Hospitals Inc Louisville, KY · General Acute Care Hospital	$4K	$2.44	1.3× median	Above Median
14	1578547865	$4K	$28.65	15.4× median	Top 10%
15	University Of Kentucky Lexington, KY · General Acute Care Hospital	$3K	$1.59	0.9× median	Below Median
16	1225033020	$3K	$8.82	4.7× median	Above 75th
17	1649270257	$3K	$12.63	6.8× median	Above 75th
18	1114367497	$3K	$25.78	13.9× median	Top 10%
19	1558313213	$2K	$13.46	7.2× median	Above 75th
20	Boston Medical Center Corporation Boston, MA · General Acute Care Hospital	$2K	$70.93	38.1× median	Top 10%

Showing top 20 of 255 providers billing this code

Related Procedures

J1950Injection, leuprolide acetate, per three point seven five milligrams$33.7M J1955$1.4M J1953$1.1M J1951$1.0M

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