#3931 of 11K

J8597

HCPCS Procedure Code

HCPCS code J8597 is the #3,931 most-billed Medicaid procedure code, with $1.0M in payments across 271K claims from 2018–2024. The national median cost per claim is $0.54. Costs vary widely — the 90th percentile is $10.02 per claim, 18.6× the median.

Total Paid

$1.0M

0.00% of all spending

Total Claims

271K

Providers

189

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for J8597? Based on 147 providers billing this code nationally.

Median

$0.54

Average

$6.05

Std Dev

$19.28

Max

$155.90

Percentile Distribution (Cost per Claim)

p10

$0.01

p25

$0.06

Median

$0.54

p75

$3.19

p90

$10.02

p95

$32.57

p99

$97.95

50% of providers bill between $0.06 and $3.19 per claim for this code.

90% bill between $0.01 and $10.02.

Top 1% bill above $97.95.

About This Procedure

HCPCS code J8597 was billed by 189 providers across 271K claims, totaling $1.0M in Medicaid payments from 2018–2024. This code was used for 232K 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

$0.54

Providers Billing

147

National Spending

$1.0M

Avg/Median Ratio

11.20×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for J8597

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Carolinas Medical Center Charlotte, NC · General Acute Care Hospital	$237K	$45.88	85.0× median	Top 10%
2	1417432840	$180K	$155.90	288.7× median	Top 1%
3	1396790325	$141K	$134.00	248.2× median	Top 1%
4	1720004450	$141K	$45.29	83.9× median	Top 10%
5	Carilion Medical Center Roanoke, VA · General Acute Care Hospital	$65K	$6.37	11.8× median	Above 75th
6	Childrens Hospital Of The Kings Daughters Inc Norfolk, VA · Social Worker, Clinical	$31K	$34.61	64.1× median	Top 10%
7	1124098421	$26K	$1.47	2.7× median	Above Median
8	1376536573	$21K	$7.68	14.2× median	Above 75th
9	1417005760	$13K	$3.09	5.7× median	Above Median
10	1710970918	$11K	$6.07	11.2× median	Above 75th
11	1194718304	$11K	$13.75	25.5× median	Top 10%
12	Uch-mhs Colorado Springs, CO · General Acute Care Hospital	$10K	$6.35	11.8× median	Above 75th
13	1528006103	$10K	$1.70	3.1× median	Above Median
14	1871606764	$8K	$3.28	6.1× median	Above 75th
15	1326442336	$8K	$3.32	6.2× median	Above 75th
16	1518950484	$7K	$8.81	16.3× median	Above 75th
17	1053301127	$5K	$1.86	3.4× median	Above Median
18	1124369137	$4K	$4.40	8.2× median	Above 75th
19	1952560914	$4K	$1.85	3.4× median	Above Median
20	1962446385	$4K	$5.09	9.4× median	Above 75th

Showing top 20 of 189 providers billing this code

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