J1955
HCPCS Procedure Code
HCPCS code J1955 is the #3,666 most-billed Medicaid procedure code, with $1.4M in payments across 21K claims from 2018–2024. The national median cost per claim is $45.31. Costs vary widely — the 90th percentile is $147.76 per claim, 3.3× the median.
Total Paid
$1.4M
0.00% of all spending
Total Claims
21K
Providers
15
Avg Cost/Claim
$65
National Cost Distribution
How much do providers bill per claim for J1955? Based on 13 providers billing this code nationally.
Median
$45.31
Average
$65.81
Std Dev
$62.26
Max
$200.14
Percentile Distribution (Cost per Claim)
50% of providers bill between $23.46 and $84.23 per claim for this code.
90% bill between $11.55 and $147.76.
Top 1% bill above $193.86.
About This Procedure
HCPCS code J1955 was billed by 15 providers across 21K claims, totaling $1.4M in Medicaid payments from 2018–2024. This code was used for 5K 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
$45.31
Providers Billing
13
National Spending
$1.4M
Avg/Median Ratio
1.45×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J1955
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1386185353 | $628K |
| 2 | 1396382685 | $285K |
| 3 | 1386187540 | $125K |
| 4 | Optum Infusion Services 308 Llc Chandler, AZ · Pharmacy Home Infusion Therapy Pharmacy | $115K |
| 5 | 1124497730 | $89K |
| 6 | 1104437219 | $49K |
| 7 | 1396852000 | $36K |
| 8 | 1821669656 | $13K |
| 9 | 1184653388 | $10K |
| 10 | 1548722127 | $7K |
| 11 | 1902191992 | $3K |
| 12 | 1093219131 | $1K |
| 13 | 1043610819 | $29 |
| 14 | 1528628633 | $0 |
| 15 | 1376737528 | $0 |
Showing top 15 of 15 providers billing this code