#5062 of 11K

J0558

HCPCS Procedure Code

HCPCS code J0558 is the #5,062 most-billed Medicaid procedure code, with $303K in payments across 4K claims from 2018–2024. The national median cost per claim is $90.80. Costs vary widely — the 90th percentile is $194.15 per claim, 2.1× the median.

Total Paid

$303K

0.00% of all spending

Total Claims

Providers

Avg Cost/Claim

$69

National Cost Distribution

How much do providers bill per claim for J0558? Based on 28 providers billing this code nationally.

Median

$90.80

Average

$92.79

Std Dev

$78.14

Max

$284.96

Percentile Distribution (Cost per Claim)

p10

$10.86

p25

$23.47

Median

$90.80

p75

$150.60

p90

$194.15

p95

$208.91

p99

$264.65

50% of providers bill between $23.47 and $150.60 per claim for this code.

90% bill between $10.86 and $194.15.

Top 1% bill above $264.65.

About This Procedure

HCPCS code J0558 was billed by 38 providers across 4K claims, totaling $303K in Medicaid payments from 2018–2024. This code was used for 4K 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

$90.80

Providers Billing

National Spending

$303K

Avg/Median Ratio

1.02×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J0558

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1811080526	$149K	$172.57	1.9× median	Above 75th
2	1790827038	$35K	$124.14	1.4× median	Above Median
3	Dayton Children's Hospital Dayton, OH · General Acute Care Hospital, Children	$26K	$166.11	1.8× median	Above 75th
4	1225450588	$15K	$284.96	3.1× median	Top 1%
5	Holzer Hospital Foundation Gallipolis, OH · General Acute Care Hospital Rural	$14K	$209.73	2.3× median	Top 10%
6	Henry Ford Health St. John Hospital Chicago, IL · Clinic/Center, Ambulatory Surgical	$8K	$27.89	0.3× median	Below Median
7	1689761942	$7K	$113.05	1.2× median	Above Median
8	1376949503	$7K	$14.61	0.2× median	Below Median
9	1326384009	$7K	$24.79	0.3× median	Below Median
10	Southern Ohio Medical Center Portsmouth, OH · Clinical Medical Laboratory	$6K	$102.17	1.1× median	Above Median
11	1922246842	$5K	$188.47	2.1× median	Above 75th
12	1023055191	$3K	$178.94	2.0× median	Above 75th
13	1811922347	$3K	$102.38	1.1× median	Above Median
14	1932664091	$3K	$8.38	0.1× median	Below Median
15	1609046267	$2K	$207.39	2.3× median	Top 10%
16	1326049347	$2K	$76.94	0.8× median	Below Median
17	1881648285	$2K	$145.44	1.6× median	Above Median
18	1538141627	$2K	$122.77	1.4× median	Above Median
19	1275504326	$1K	$98.70	1.1× median	Above Median
20	1982861019	$1K	$82.90	0.9× median	Below Median

Showing top 20 of 38 providers billing this code

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