J1569
HCPCS Procedure Code
HCPCS code J1569 is the #606 most-billed Medicaid procedure code, with $127.7M in payments across 86K claims from 2018–2024. The national median cost per claim is $1,387.65. Costs vary widely — the 90th percentile is $3,749.10 per claim, 2.7× the median.
Total Paid
$127.7M
0.01% of all spending
Total Claims
86K
Providers
90
Avg Cost/Claim
$1K
National Cost Distribution
How much do providers bill per claim for J1569? Based on 87 providers billing this code nationally.
Median
$1,387.65
Average
$1,864.24
Std Dev
$1,924.94
Max
$14,674.48
Percentile Distribution (Cost per Claim)
50% of providers bill between $781.08 and $2,269.97 per claim for this code.
90% bill between $255.37 and $3,749.10.
Top 1% bill above $7,270.28.
About This Procedure
HCPCS code J1569 was billed by 90 providers across 86K claims, totaling $127.7M in Medicaid payments from 2018–2024. This code was used for 42K 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
$1,387.65
Providers Billing
87
National Spending
$127.7M
Avg/Median Ratio
1.34×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J1569
| # | Provider | Total Paid |
|---|---|---|
| 1 | Virginia Commonwealth University Health System Authority Richmond, VA · General Acute Care Hospital | $9.9M |
| 2 | Accredo Health Group Inc Warrendale, PA · Pharmacy, Community/Retail Pharmacy | $9.6M |
| 3 | Regents Of The University Of Michigan Ann Arbor, MI · Clinic/Center, End-Stage Renal Disease (ESRD) Treatment | $7.0M |
| 4 | The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital | $5.9M |
| 5 | Egleston Children's Hospital At Emory University Inc. Atlanta, GA · Pediatrics Pediatric Emergency Medicine | $5.4M |
| 6 | The General Hospital Corporation Boston, MA · General Acute Care Hospital | $4.4M |
| 7 | Seattle Children's Hospital Seattle, WA · Prosthetic/Orthotic Supplier | $4.4M |
| 8 | 1891071098 | $4.4M |
| 9 | Indiana University Health, Inc Indianapolis, IN · Durable Medical Equipment & Medical Supplies | $4.0M |
| 10 | Phoenix Children's Hospital Phoenix, AZ · General Acute Care Hospital Children | $3.9M |
| 11 | 1073054714 | $3.4M |
| 12 | 1568474716 | $3.2M |
| 13 | Optum Infusion Services 308 Llc Chandler, AZ · Pharmacy Home Infusion Therapy Pharmacy | $2.8M |
| 14 | Children's Hospital Corporation Boston, MA · Clinic/Center | $2.7M |
| 15 | Children's Hospital Medical Center Cincinnati, OH · Clinic/Center, Primary Care | $2.7M |
| 16 | 1841832466 | $2.6M |
| 17 | Alivia Specialty Llc Guaynabo, PR · Pharmacy Specialty Pharmacy | $2.4M |
| 18 | Upmc Children's Hospital Of Pittsburgh Pittsburgh, PA · Clinic/Center | $2.4M |
| 19 | 1487609269 | $2.3M |
| 20 | Childrens Hospital Of The Kings Daughters Inc Norfolk, VA · Social Worker, Clinical | $2.3M |
Showing top 20 of 90 providers billing this code