J0173
HCPCS Procedure Code
HCPCS code J0173 is the #8,071 most-billed Medicaid procedure code, with $6K in payments across 6K claims from 2018–2024. The national median cost per claim is $1.35. Costs vary widely — the 90th percentile is $11.58 per claim, 8.6× the median.
Total Paid
$6K
0.00% of all spending
Total Claims
6K
Providers
36
Avg Cost/Claim
$1
National Cost Distribution
How much do providers bill per claim for J0173? Based on 16 providers billing this code nationally.
Median
$1.35
Average
$4.09
Std Dev
$7.05
Max
$26.55
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.27 and $3.22 per claim for this code.
90% bill between $0.04 and $11.58.
Top 1% bill above $24.40.
About This Procedure
HCPCS code J0173 was billed by 36 providers across 6K claims, totaling $6K in Medicaid payments from 2018–2024. This code was used for 5K 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
$1.35
Providers Billing
16
National Spending
$6K
Avg/Median Ratio
3.03×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J0173
| # | Provider | Total Paid |
|---|---|---|
| 1 | Stanford Health Care Stanford, CA · General Acute Care Hospital | $3K |
| 2 | 1639101751 | $2K |
| 3 | 1700801909 | $558 |
| 4 | Riverside Hospital Inc Newport News, VA · Psychiatric Hospital | $532 |
| 5 | St Josephs University Medical Center Inc. Paterson, NJ · General Acute Care Hospital | $442 |
| 6 | Unm Hospital Albuquerque, NM · General Acute Care Hospital | $231 |
| 7 | Keck Medical Center Of Usc Los Angeles, CA · General Acute Care Hospital | $183 |
| 8 | Froedtert Memorial Lutheran Hospital, Inc. Milwaukee, WI · Clinic/Center, Radiology | $161 |
| 9 | 1821098286 | $85 |
| 10 | Southern Ohio Medical Center Portsmouth, OH · Clinical Medical Laboratory | $75 |
| 11 | Ohiohealth Corporation Columbus, OH · General Acute Care Hospital | $16 |
| 12 | 1477508687 | $16 |
| 13 | University Hospitals Cleveland Medical Center Cleveland, OH · General Acute Care Hospital | $14 |
| 14 | Ohio State University Hospitals Columbus, OH · General Acute Care Hospital | $13 |
| 15 | Nyu Langone Hospitals New York, NY · Clinic/Center, Oncology | $9 |
| 16 | 1255387726 | $1 |
| 17 | 1316692585 | $0 |
| 18 | 1265740195 | $0 |
| 19 | 1366444507 | $0 |
| 20 | Southcoast Hospitals Group, Inc New Bedford, MA · General Acute Care Hospital | $0 |
Showing top 20 of 36 providers billing this code