J7192
Factor VIII (recombinant antihemophilic factor), per IU
Factor VIII (recombinant antihemophilic factor), per IU is the #1,082 most-billed Medicaid procedure code, with $42.4M in payments across 4K claims from 2018–2024. The national median cost per claim is $8,137.49.
Total Paid
$42.4M
0.00% of all spending
Total Claims
4K
Providers
6
Avg Cost/Claim
$10K
National Cost Distribution
How much do providers bill per claim for J7192? Based on 6 providers billing this code nationally.
Median
$8,137.49
Average
$7,789.97
Std Dev
$4,980.95
Max
$16,022.35
Percentile Distribution (Cost per Claim)
50% of providers bill between $3,863.85 and $9,089.54 per claim for this code.
90% bill between $2,636.69 and $12,595.72.
Top 1% bill above $15,679.69.
About This Procedure
HCPCS code J7192 (Factor VIII (recombinant antihemophilic factor), per IU) was billed by 6 providers across 4K claims, totaling $42.4M in Medicaid payments from 2018–2024. This code was used for 2K 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
$8,137.49
Providers Billing
6
National Spending
$42.4M
Avg/Median Ratio
0.96×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J7192
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1053799403 | $25.0M |
| 2 | Washington Institute For Coagulation Seattle, WA · Pharmacy, Specialty Pharmacy | $8.7M |
| 3 | 1972688919 | $5.0M |
| 4 | Accredo Health Group Inc Warrendale, PA · Pharmacy, Community/Retail Pharmacy | $3.0M |
| 5 | 1659364800 | $609K |
| 6 | 1013998921 | $65K |
Showing top 6 of 6 providers billing this code