#6535 of 11K

J0595

HCPCS Procedure Code

HCPCS code J0595 is the #6,535 most-billed Medicaid procedure code, with $58K in payments across 12K claims from 2018–2024. The national median cost per claim is $2.82. Costs vary widely — the 90th percentile is $7.34 per claim, 2.6× the median.

Total Paid

$58K

0.00% of all spending

Total Claims

12K

Providers

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for J0595? Based on 33 providers billing this code nationally.

Median

$2.82

Average

$3.75

Std Dev

$4.02

Max

$16.16

Percentile Distribution (Cost per Claim)

p10

$0.19

p25

$0.73

Median

$2.82

p75

$5.01

p90

$7.34

p95

$12.68

p99

$15.58

50% of providers bill between $0.73 and $5.01 per claim for this code.

90% bill between $0.19 and $7.34.

Top 1% bill above $15.58.

About This Procedure

HCPCS code J0595 was billed by 54 providers across 12K claims, totaling $58K in Medicaid payments from 2018–2024. This code was used for 9K 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

$2.82

Providers Billing

National Spending

$58K

Avg/Median Ratio

1.33×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J0595

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1063484483	$33K	$14.34	5.1× median	Top 10%
2	1356444814	$9K	$7.46	2.6× median	Top 10%
3	1538101688	$5K	$5.01	1.8× median	Above Median
4	1003898313	$3K	$4.84	1.7× median	Above Median
5	1427055821	$2K	$2.89	1.0× median	Above Median
6	Baptist Healthcare System Inc Corbin, KY · General Acute Care Hospital	$2K	$4.08	1.4× median	Above Median
7	St. Mary's Medical Center Inc Huntington, WV · General Acute Care Hospital	$1K	$11.57	4.1× median	Top 10%
8	1992789721	$515	$4.77	1.7× median	Above Median
9	Dallas County Hospital District Dallas, TX · Clinic/Center, Ambulatory Surgical	$445	$5.94	2.1× median	Above 75th
10	1710109186	$361	$5.55	2.0× median	Above 75th
11	Uofl Health-louisville Inc Louisville, KY · Psychiatric Hospital	$320	$5.01	1.8× median	Above Median
12	1083759633	$311	$1.25	0.4× median	Below Median
13	1720086176	$280	$5.72	2.0× median	Above 75th
14	1710463146	$235	$0.49	0.2× median	Below Median
15	1992893416	$194	$16.16	5.7× median	Top 1%
16	1710943881	$143	$0.35	0.1× median	Below Median
17	1225061419	$138	$4.32	1.5× median	Above Median
18	1447457775	$130	$2.78	1.0× median	Below Median
19	1447231956	$117	$6.85	2.4× median	Above 75th
20	1427132158	$108	$3.49	1.2× median	Above Median

Showing top 20 of 54 providers billing this code

Related Procedures

J0585Injection, onabotulinumtoxinA, 1 unit$506.8M J0604$25.7M J0586$14.2M J0600$4.5M J0588$3.2M

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