J1459
HCPCS Procedure Code
HCPCS code J1459 is the #827 most-billed Medicaid procedure code, with $71.1M in payments across 61K claims from 2018–2024. The national median cost per claim is $949.14. Costs vary widely — the 90th percentile is $2,812.38 per claim, 3.0× the median.
Total Paid
$71.1M
0.01% of all spending
Total Claims
61K
Providers
54
Avg Cost/Claim
$1K
National Cost Distribution
How much do providers bill per claim for J1459? Based on 51 providers billing this code nationally.
Median
$949.14
Average
$1,348.48
Std Dev
$1,673.14
Max
$11,024.10
Percentile Distribution (Cost per Claim)
50% of providers bill between $500.04 and $1,498.45 per claim for this code.
90% bill between $234.41 and $2,812.38.
Top 1% bill above $7,480.03.
About This Procedure
HCPCS code J1459 was billed by 54 providers across 61K claims, totaling $71.1M in Medicaid payments from 2018–2024. This code was used for 22K 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
$949.14
Providers Billing
51
National Spending
$71.1M
Avg/Median Ratio
1.42×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J1459
| # | Provider | Total Paid |
|---|---|---|
| 1 | Yale New Haven Hospital New Haven, CT · General Acute Care Hospital | $16.8M |
| 2 | Phoenix Children's Hospital Phoenix, AZ · General Acute Care Hospital Children | $11.1M |
| 3 | Rector & Visitors Of The University Of Virginia Charlottesville, VA · General Acute Care Hospital | $9.6M |
| 4 | State Of Connecticut Farmington, CT · Counselor, Professional | $5.9M |
| 5 | University Of Rochester Rochester, NY · General Acute Care Hospital | $4.6M |
| 6 | Ohio State University Hospitals Columbus, OH · General Acute Care Hospital | $3.5M |
| 7 | Mainehealth Portland, ME · Emergency Medicine | $2.8M |
| 8 | West Virginia University Hospitals, Inc Morgantown, WV · Clinical Medical Laboratory | $1.5M |
| 9 | 1639172372 | $1.4M |
| 10 | Alameda Health System Oakland, CA · General Acute Care Hospital | $1.4M |
| 11 | Stamford Hospital Stamford, CT · Hospitalist | $1.3M |
| 12 | Spectrum Health Hospitals Grand Rapids, MI · General Acute Care Hospital | $1.2M |
| 13 | Stanford Health Care Stanford, CA · General Acute Care Hospital | $1.1M |
| 14 | Inova Health Care Services Falls Church, VA · Clinic/Center, Rehabilitation, Substance Use Disorder | $824K |
| 15 | 1437119310 | $732K |
| 16 | State Of Mississippi - University Of Mississippi Medical Center Jackson, MS · General Acute Care Hospital | $704K |
| 17 | Umass Memorial Medical Center, Inc. Worcester, MA · General Acute Care Hospital | $702K |
| 18 | 1770039885 | $672K |
| 19 | The Milton S Hershey Medical Center Hershey, PA · General Acute Care Hospital | $664K |
| 20 | Froedtert Memorial Lutheran Hospital, Inc. Milwaukee, WI · Clinic/Center, Radiology | $660K |
Showing top 20 of 54 providers billing this code