J7170
Emicizumab-kxwh (Hemlibra) injection, 0.5 mg
Emicizumab-kxwh (Hemlibra) injection, 0.5 mg is the #418 most-billed Medicaid procedure code, with $247.0M in payments across 10K claims from 2018–2024. The national median cost per claim is $23,418.64.
Total Paid
$247.0M
0.02% of all spending
Total Claims
10K
Providers
13
Avg Cost/Claim
$24K
National Cost Distribution
How much do providers bill per claim for J7170? Based on 13 providers billing this code nationally.
Median
$23,418.64
Average
$27,156.58
Std Dev
$19,501.98
Max
$85,179.04
Percentile Distribution (Cost per Claim)
50% of providers bill between $20,800.33 and $30,055.18 per claim for this code.
90% bill between $13,882.29 and $33,274.51.
Top 1% bill above $79,043.03.
About This Procedure
HCPCS code J7170 (Emicizumab-kxwh (Hemlibra) injection, 0.5 mg) was billed by 13 providers across 10K claims, totaling $247.0M in Medicaid payments from 2018–2024. This code was used for 8K 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
$23,418.64
Providers Billing
13
National Spending
$247.0M
Avg/Median Ratio
1.16×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J7170
| # | Provider | Total Paid |
|---|---|---|
| 1 | Washington Institute For Coagulation Seattle, WA · Pharmacy, Specialty Pharmacy | $88.1M |
| 2 | 1972688919 | $44.3M |
| 3 | Long Island Jewish Medical Center New Hyde Park, NY · General Acute Care Hospital | $26.5M |
| 4 | 1568428621 | $22.9M |
| 5 | 1053799403 | $20.5M |
| 6 | Procare Pharmacy Direct, Llc. Monroeville, PA · Pharmacy, Community/Retail Pharmacy | $16.6M |
| 7 | Accredo Health Group Inc Warrendale, PA · Pharmacy, Community/Retail Pharmacy | $10.7M |
| 8 | Nationwide Children's Hospital Columbus, OH · Durable Medical Equipment & Medical Supplies | $7.3M |
| 9 | 1417955170 | $5.0M |
| 10 | The New York And Presbyterian Hospital New York, NY · General Acute Care Hospital | $3.1M |
| 11 | 1245248939 | $1.2M |
| 12 | 1629116645 | $815K |
| 13 | 1295743060 | $800 |
Showing top 13 of 13 providers billing this code