#1105 of 11K

J3590

Unclassified biologic drug injection

Unclassified biologic drug injection is the #1,105 most-billed Medicaid procedure code, with $40.5M in payments across 155K claims from 2018–2024. The national median cost per claim is $24.77. Costs vary widely — the 90th percentile is $1,032.96 per claim, 41.7× the median.

Total Paid

$40.5M

0.00% of all spending

Total Claims

155K

Providers

200

Avg Cost/Claim

$262

National Cost Distribution

How much do providers bill per claim for J3590? Based on 142 providers billing this code nationally.

Median

$24.77

Average

$455.02

Std Dev

$1,426.88

Max

$11,622.44

Percentile Distribution (Cost per Claim)

p10

$0.09

p25

$3.77

Median

$24.77

p75

$76.80

p90

$1,032.96

p95

$2,925.71

p99

$6,880.64

50% of providers bill between $3.77 and $76.80 per claim for this code.

90% bill between $0.09 and $1,032.96.

Top 1% bill above $6,880.64.

About This Procedure

HCPCS code J3590 (Unclassified biologic drug injection) was billed by 200 providers across 155K claims, totaling $40.5M in Medicaid payments from 2018–2024. This code was used for 94K 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

$24.77

Providers Billing

142

National Spending

$40.5M

Avg/Median Ratio

18.37×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for J3590

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1518039858	$27.4M	$4,401.71	177.7× median	Top 10%
2	1265418891	$3.9M	$3,271.31	132.1× median	Top 10%
3	1992786495	$1.5M	$1,216.62	49.1× median	Top 10%
4	Dayton Children's Hospital Dayton, OH · General Acute Care Hospital, Children	$1.1M	$1,916.59	77.4× median	Top 10%
5	1114239332	$724K	$1,531.66	61.8× median	Top 10%
6	Procare Pharmacy Direct, Llc. Monroeville, PA · Pharmacy, Community/Retail Pharmacy	$709K	$6,389.45	258.0× median	Top 10%
7	1295443216	$700K	$3,519.15	142.1× median	Top 10%
8	1255644357	$577K	$866.15	35.0× median	Above 75th
9	1316213531	$511K	$11,622.44	469.2× median	Top 1%
10	1477532174	$412K	$70.30	2.8× median	Above Median
11	1508315128	$355K	$2,038.48	82.3× median	Top 10%
12	1972894772	$266K	$2,956.19	119.3× median	Top 10%
13	1013998921	$202K	$659.33	26.6× median	Above 75th
14	1801048699	$186K	$77.10	3.1× median	Above 75th
15	1972514503	$147K	$466.91	18.8× median	Above 75th
16	1225001654	$138K	$681.42	27.5× median	Above 75th
17	1215124797	$119K	$720.63	29.1× median	Above 75th
18	1093748071	$116K	$373.46	15.1× median	Above 75th
19	1841249265	$115K	$34.26	1.4× median	Above Median
20	1962485342	$112K	$49.01	2.0× median	Above Median

Showing top 20 of 200 providers billing this code

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