J0561
HCPCS Procedure Code
HCPCS code J0561 is the #1,619 most-billed Medicaid procedure code, with $17.6M in payments across 162K claims from 2018–2024. The national median cost per claim is $96.49. Costs vary widely — the 90th percentile is $242.23 per claim, 2.5× the median.
Total Paid
$17.6M
0.00% of all spending
Total Claims
162K
Providers
622
Avg Cost/Claim
$109
National Cost Distribution
How much do providers bill per claim for J0561? Based on 532 providers billing this code nationally.
Median
$96.49
Average
$114.07
Std Dev
$105.71
Max
$739.37
Percentile Distribution (Cost per Claim)
50% of providers bill between $30.65 and $167.13 per claim for this code.
90% bill between $5.54 and $242.23.
Top 1% bill above $448.88.
About This Procedure
HCPCS code J0561 was billed by 622 providers across 162K claims, totaling $17.6M in Medicaid payments from 2018–2024. This code was used for 136K 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
$96.49
Providers Billing
532
National Spending
$17.6M
Avg/Median Ratio
1.18×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J0561
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1275550212 | $852K |
| 2 | Yukon-kuskokwim Health Corporation Bethel, AK · General Acute Care Hospital Rural | $782K |
| 3 | Arrowhead Regional Medical Center Colton, CA · General Acute Care Hospital | $681K |
| 4 | State Of Mississippi - University Of Mississippi Medical Center Jackson, MS · General Acute Care Hospital | $536K |
| 5 | Ohiohealth Corporation Columbus, OH · General Acute Care Hospital | $502K |
| 6 | The Metrohealth System Cleveland, OH · General Acute Care Hospital | $415K |
| 7 | Yale New Haven Hospital New Haven, CT · General Acute Care Hospital | $410K |
| 8 | 1083659734 | $366K |
| 9 | Norton Sound Health Corporation Nome, AK · General Acute Care Hospital, Critical Access | $362K |
| 10 | 1548393127 | $333K |
| 11 | 1447299797 | $320K |
| 12 | Norton Hospitals, Inc Louisville, KY · General Acute Care Hospital | $293K |
| 13 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $286K |
| 14 | 1235297847 | $277K |
| 15 | St Lukes Roosevelt Hospital Center New York, NY · Case Management | $267K |
| 16 | The New York And Presbyterian Hospital New York, NY · General Acute Care Hospital | $252K |
| 17 | Alameda Health System Oakland, CA · General Acute Care Hospital | $232K |
| 18 | The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital | $229K |
| 19 | 1578527172 | $222K |
| 20 | Uofl Health-louisville Inc Louisville, KY · Psychiatric Hospital | $212K |
Showing top 20 of 622 providers billing this code