J9171
HCPCS Procedure Code
HCPCS code J9171 is the #3,245 most-billed Medicaid procedure code, with $2.1M in payments across 19K claims from 2018–2024. The national median cost per claim is $97.17. Costs vary widely — the 90th percentile is $244.92 per claim, 2.5× the median.
Total Paid
$2.1M
0.00% of all spending
Total Claims
19K
Providers
64
Avg Cost/Claim
$113
National Cost Distribution
How much do providers bill per claim for J9171? Based on 59 providers billing this code nationally.
Median
$97.17
Average
$244.55
Std Dev
$622.59
Max
$3,903.25
Percentile Distribution (Cost per Claim)
50% of providers bill between $45.35 and $149.51 per claim for this code.
90% bill between $11.75 and $244.92.
Top 1% bill above $3,185.56.
About This Procedure
HCPCS code J9171 was billed by 64 providers across 19K claims, totaling $2.1M in Medicaid payments from 2018–2024. This code was used for 11K 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
$97.17
Providers Billing
59
National Spending
$2.1M
Avg/Median Ratio
2.52×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J9171
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1003989831 | $359K |
| 2 | Alivia Specialty Llc Guaynabo, PR · Pharmacy Specialty Pharmacy | $269K |
| 3 | City Of Hope National Medical Center Duarte, CA · General Acute Care Hospital | $179K |
| 4 | 1811419575 | $179K |
| 5 | 1538157508 | $129K |
| 6 | 1457409674 | $119K |
| 7 | Norton Hospitals, Inc Louisville, KY · General Acute Care Hospital | $116K |
| 8 | Regents Of The University Of California San Diego, CA · General Acute Care Hospital | $73K |
| 9 | Yale New Haven Hospital New Haven, CT · General Acute Care Hospital | $72K |
| 10 | Dana-farber Cancer Institute, Inc. Boston, MA · General Acute Care Hospital | $54K |
| 11 | Arthur G James Cancer Hospital And Research Institute Columbus, OH · Special Hospital | $50K |
| 12 | Memorial Hospital For Cancer And Allied Diseases New York, NY · Pharmacy | $48K |
| 13 | Best Option Healthcare Puerto Rico Llc San Juan, PR · Pharmacy Home Infusion Therapy Pharmacy | $47K |
| 14 | The Cooper Health System Camden, NJ · General Acute Care Hospital | $45K |
| 15 | Stanford Health Care Stanford, CA · General Acute Care Hospital | $40K |
| 16 | 1679660617 | $34K |
| 17 | 1528018389 | $33K |
| 18 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $25K |
| 19 | 1457361271 | $20K |
| 20 | Unm Hospital Albuquerque, NM · General Acute Care Hospital | $18K |
Showing top 20 of 64 providers billing this code