J9271
Injection, pembrolizumab, 1 mg
Injection, pembrolizumab, 1 mg is the #151 most-billed Medicaid procedure code, with $1.23B in payments across 231K claims from 2018–2024. The national median cost per claim is $5,391.55.
Total Paid
$1.23B
0.11% of all spending
Total Claims
231K
Providers
305
Avg Cost/Claim
$5K
National Cost Distribution
How much do providers bill per claim for J9271? Based on 292 providers billing this code nationally.
Median
$5,391.55
Average
$5,610.93
Std Dev
$3,400.92
Max
$17,999.14
Percentile Distribution (Cost per Claim)
50% of providers bill between $3,123.83 and $7,713.83 per claim for this code.
90% bill between $1,238.40 and $10,208.61.
Top 1% bill above $13,847.59.
About This Procedure
HCPCS code J9271 (Injection, pembrolizumab, 1 mg) was billed by 305 providers across 231K claims, totaling $1.23B in Medicaid payments from 2018–2024. This code was used for 159K 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
$5,391.55
Providers Billing
292
National Spending
$1.23B
Avg/Median Ratio
1.04×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J9271
| # | Provider | Total Paid |
|---|---|---|
| 1 | Alivia Specialty Llc Guaynabo, PR · Pharmacy Specialty Pharmacy | $58.9M |
| 2 | 1003989831 | $38.9M |
| 3 | Dana-farber Cancer Institute, Inc. Boston, MA · General Acute Care Hospital | $33.0M |
| 4 | Yale New Haven Hospital New Haven, CT · General Acute Care Hospital | $30.9M |
| 5 | Long Island Jewish Medical Center New Hyde Park, NY · General Acute Care Hospital | $30.2M |
| 6 | University Of Kentucky Lexington, KY · General Acute Care Hospital | $29.0M |
| 7 | Arthur G James Cancer Hospital And Research Institute Columbus, OH · Special Hospital | $27.3M |
| 8 | Stanford Health Care Stanford, CA · General Acute Care Hospital | $24.5M |
| 9 | Regents Of The University Of California San Diego, CA · General Acute Care Hospital | $24.2M |
| 10 | 1437230034 | $21.5M |
| 11 | City Of Hope National Medical Center Duarte, CA · General Acute Care Hospital | $21.3M |
| 12 | University Of California Irvine Orange, CA · General Acute Care Hospital | $20.4M |
| 13 | University Medical Center, Inc Louisville, KY · Student in an Organized Health Care Education/Training Program | $19.2M |
| 14 | 1295023547 | $18.0M |
| 15 | The Cooper Health System Camden, NJ · General Acute Care Hospital | $17.8M |
| 16 | Hmh Hospitals Corporation Hackensack, NJ · Ambulance | $17.0M |
| 17 | 1528018389 | $16.9M |
| 18 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $16.5M |
| 19 | Banner - University Medical Center Tucson Campus Llc Tucson, AZ · Clinic/Center, Multi-Specialty | $16.4M |
| 20 | Memorial Hospital For Cancer And Allied Diseases New York, NY · Pharmacy | $15.5M |
Showing top 20 of 305 providers billing this code