#3176 of 11K

J1437

HCPCS Procedure Code

HCPCS code J1437 is the #3,176 most-billed Medicaid procedure code, with $2.3M in payments across 2K claims from 2018–2024. The national median cost per claim is $979.19. Costs vary widely — the 90th percentile is $1,974.76 per claim, 2.0× the median.

Total Paid

$2.3M

0.00% of all spending

Total Claims

Providers

Avg Cost/Claim

$1K

National Cost Distribution

How much do providers bill per claim for J1437? Based on 23 providers billing this code nationally.

Median

$979.19

Average

$1,162.00

Std Dev

$745.74

Max

$3,131.43

Percentile Distribution (Cost per Claim)

p10

$409.85

p25

$511.03

Median

$979.19

p75

$1,729.85

p90

$1,974.76

p95

$2,007.91

p99

$2,884.57

50% of providers bill between $511.03 and $1,729.85 per claim for this code.

90% bill between $409.85 and $1,974.76.

Top 1% bill above $2,884.57.

About This Procedure

HCPCS code J1437 was billed by 25 providers across 2K claims, totaling $2.3M in Medicaid payments from 2018–2024. This code was used for 2K 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

$979.19

Providers Billing

National Spending

$2.3M

Avg/Median Ratio

1.19×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J1437

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1306828678	$461K	$1,994.90	2.0× median	Top 10%
2	1831485267	$330K	$1,894.22	1.9× median	Above 75th
3	Ahs Hospital Corp. Summit, NJ · General Acute Care Hospital	$212K	$1,604.03	1.6× median	Above Median
4	Boston Medical Center Corporation Boston, MA · General Acute Care Hospital	$183K	$830.80	0.8× median	Below Median
5	Suny Health Science Center At Syracuse Syracuse, NY · General Acute Care Hospital	$169K	$405.93	0.4× median	Below Median
6	1528018389	$168K	$1,398.55	1.4× median	Above Median
7	1407117948	$137K	$1,820.03	1.9× median	Above 75th
8	1235199316	$97K	$922.61	0.9× median	Below Median
9	Beth Israel Deaconess Medical Center, Inc. Boston, MA · General Acute Care Hospital	$96K	$456.13	0.5× median	Below Median
10	1265929723	$84K	$565.93	0.6× median	Below Median
11	Nyu Langone Hospitals New York, NY · Clinic/Center, Oncology	$78K	$3,131.43	3.2× median	Top 1%
12	1780107797	$52K	$2,009.35	2.1× median	Top 10%
13	1013981554	$40K	$1,489.16	1.5× median	Above Median
14	University Of Rochester Rochester, NY · General Acute Care Hospital	$33K	$591.31	0.6× median	Below Median
15	1457409674	$29K	$450.68	0.5× median	Below Median
16	Ashland Hospital Corporation Ashland, KY · Clinic/Center, Rural Health	$28K	$979.19	1.0× median	Below Median
17	1255343521	$27K	$1,772.47	1.8× median	Above 75th
18	Mainehealth Portland, ME · Emergency Medicine	$22K	$1,687.23	1.7× median	Above Median
19	1215030697	$19K	$1,142.00	1.2× median	Above Median
20	Southcoast Hospitals Group, Inc New Bedford, MA · General Acute Care Hospital	$10K	$685.67	0.7× median	Below Median

Showing top 20 of 25 providers billing this code

Related Procedures

J1428Eteplirsen (Exondys 51) injection, 10 mg$92.3M J1439$54.5M J1447$39.3M J1438$5.0M J1444$2.2M

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