J1454
HCPCS Procedure Code
HCPCS code J1454 is the #3,452 most-billed Medicaid procedure code, with $1.7M in payments across 3K claims from 2018–2024. The national median cost per claim is $286.68. Costs vary widely — the 90th percentile is $1,042.47 per claim, 3.6× the median.
Total Paid
$1.7M
0.00% of all spending
Total Claims
3K
Providers
9
Avg Cost/Claim
$539
National Cost Distribution
How much do providers bill per claim for J1454? Based on 9 providers billing this code nationally.
Median
$286.68
Average
$492.00
Std Dev
$543.61
Max
$1,774.25
Percentile Distribution (Cost per Claim)
50% of providers bill between $113.92 and $497.05 per claim for this code.
90% bill between $94.45 and $1,042.47.
Top 1% bill above $1,701.07.
About This Procedure
HCPCS code J1454 was billed by 9 providers across 3K claims, totaling $1.7M 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
$286.68
Providers Billing
9
National Spending
$1.7M
Avg/Median Ratio
1.72×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for J1454
| # | Provider | Total Paid |
|---|---|---|
| 1 | Arthur G James Cancer Hospital And Research Institute Columbus, OH · Special Hospital | $797K |
| 2 | 1528018389 | $359K |
| 3 | 1235199316 | $248K |
| 4 | 1104856095 | $206K |
| 5 | 1326046467 | $18K |
| 6 | 1447276605 | $16K |
| 7 | 1700977105 | $15K |
| 8 | 1083661607 | $7K |
| 9 | 1477668572 | $2K |
Showing top 9 of 9 providers billing this code