The Most Expensive Things Medicaid Pays For
Some Medicaid claims cost more than a house. The most expensive single procedure code averages $92,158 per claim. Here's what the most expensive items on the Medicaid bill actually are.
Most Expensive Per Claim
$92K
J2326 — Nusinersen (Spinraza), 12 mg intrathecal injection
1K claims · $124.7M total · 3 providers
The most expensive procedures in Medicaid are overwhelmingly specialty drug injections. These are J-codes — the HCPCS billing codes used for drugs administered by healthcare providers rather than dispensed at pharmacies. Many treat rare, life-threatening conditions.
Why are these so expensive?
J2326 (Nusinersen (Spinraza), 12 mg intrathecal injection) treats spinal muscular atrophy (SMA), a rare genetic disease. The drug costs approximately $750,000 for the first year of treatment.J7170 (Emicizumab-kxwh (Hemlibra) injection, 0.5 mg) treats hemophilia, costing up to $500,000/year. These are genuine lifesaving treatments, but their costs reveal the enormous financial pressure specialty drugs place on Medicaid.
Note how concentrated these drugs are: J2326 is billed by only 3 providers, and J1426 (Casimersen (Amondys 45) injection, 10 mg) by just 1 provider. These are specialty centers — often the only facilities in a region that can administer these treatments.
Top 10 Most Expensive Per Claim
Nusinersen (Spinraza), 12 mg intrathecal injection
$92K
1K claims · 3 providers
Casimersen (Amondys 45) injection, 10 mg
$32K
2K claims · 1 provider
Emicizumab-kxwh (Hemlibra) injection, 0.5 mg
$24K
10K claims · 13 providers
Eteplirsen (Exondys 51) injection, 10 mg
$21K
4K claims · 1 provider
Insertion of brain-computer interface
$16K
2K claims · 9 providers
Ocrelizumab (Ocrevus) injection, 1 mg
$16K
24K claims · 68 providers
Burosumab-twza (Crysvita) injection, 1 mg
$16K
11K claims · 7 providers
Membrane graft or membrane wrap, per sq cm
$10K
6K claims · 11 providers
Factor VIII (recombinant antihemophilic factor), per IU
$10K
4K claims · 6 providers
Ustekinumab (Stelara) injection, 1 mg
$8K
3K claims · 7 providers
All 50 Most Expensive Procedures
| # | Code | Description | Cost/Claim | Total Paid | Claims | Providers |
|---|---|---|---|---|---|---|
| 1 | J2326 | Nusinersen (Spinraza), 12 mg intrathecal injection | $92K | $124.7M | 1K | 3 |
| 2 | J1426 | Casimersen (Amondys 45) injection, 10 mg | $32K | $65.6M | 2K | 1 |
| 3 | J7170 | Emicizumab-kxwh (Hemlibra) injection, 0.5 mg | $24K | $247.0M | 10K | 13 |
| 4 | J1428 | Eteplirsen (Exondys 51) injection, 10 mg | $21K | $92.3M | 4K | 1 |
| 5 | 0128 | Insertion of brain-computer interface | $16K | $39.6M | 2K | 9 |
| 6 | J2350 | Ocrelizumab (Ocrevus) injection, 1 mg | $16K | $391.8M | 24K | 68 |
| 7 | J0584 | Burosumab-twza (Crysvita) injection, 1 mg | $16K | $168.4M | 11K | 7 |
| 8 | Q4205 | Membrane graft or membrane wrap, per sq cm | $10K | $58.8M | 6K | 11 |
| 9 | J7192 | Factor VIII (recombinant antihemophilic factor), per IU | $10K | $42.4M | 4K | 6 |
| 10 | J3357 | Ustekinumab (Stelara) injection, 1 mg | $8K | $21.4M | 3K | 7 |
| 11 | E0766 | — | $8K | $112.8M | 15K | 1 |
| 12 | 0681 | — | $7K | $22.0M | 3K | 9 |
| 13 | 0120 | — | $7K | $157.8M | 23K | 41 |
| 14 | T2039 | — | $6K | $30.5M | 5K | 9 |
| 15 | J9271 | Injection, pembrolizumab, 1 mg | $5K | $1.23B | 231K | 305 |
| 16 | A4575 | — | $5K | $87.5M | 17K | 8 |
| 17 | 21299 | — | $5K | $52.8M | 10K | 1 |
| 18 | S3870 | — | $5K | $26.4M | 5K | 1 |
| 19 | 0101 | — | $5K | $66.0M | 13K | 31 |
| 20 | L8619 | — | $5K | $123.6M | 25K | 3 |
| 21 | W0260 | — | $5K | $16.0M | 3K | 16 |
| 22 | J9354 | — | $5K | $5.4M | 1K | 4 |
| 23 | 0121 | Revenue code, all-inclusive room and board | $5K | $195.0M | 42K | 74 |
| 24 | J3285 | — | $4K | $107.8M | 25K | 9 |
| 25 | B4105 | — | $4K | $28.5M | 7K | 22 |
| 26 | J9358 | — | $4K | $25.2M | 6K | 15 |
| 27 | E2510 | Speech generating device, synthesized speech, multiple methods | $4K | $547.0M | 133K | 24 |
| 28 | J9022 | — | $4K | $17.9M | 4K | 23 |
| 29 | J0791 | — | $4K | $14.0M | 4K | 10 |
| 30 | 33285 | — | $4K | $6.3M | 2K | 5 |
| 31 | J9299 | Nivolumab (Opdivo) injection, 1 mg | $4K | $218.8M | 59K | 96 |
| 32 | SRX01 | — | $4K | $5.2M | 1K | 2 |
| 33 | E1220 | — | $4K | $14.6M | 4K | 9 |
| 34 | J0491 | — | $4K | $4.4M | 1K | 11 |
| 35 | J9173 | — | $4K | $11.2M | 3K | 18 |
| 36 | J7205 | — | $4K | $4.8M | 1K | 1 |
| 37 | 27130 | — | $4K | $10.0M | 3K | 32 |
| 38 | J3380 | — | $3K | $141.2M | 40K | 101 |
| 39 | Q4236 | — | $3K | $4.2M | 1K | 4 |
| 40 | E1007 | — | $3K | $95.1M | 28K | 92 |
| 41 | 0123 | — | $3K | $29.7M | 9K | 16 |
| 42 | J2323 | — | $3K | $180.2M | 58K | 90 |
| 43 | J9306 | — | $3K | $77.0M | 25K | 48 |
| 44 | 43659 | — | $3K | $7.0M | 2K | 9 |
| 45 | J9144 | — | $3K | $67.1M | 22K | 44 |
| 46 | J0517 | — | $3K | $10.5M | 3K | 16 |
| 47 | J7686 | — | $3K | $16.8M | 6K | 3 |
| 48 | 24538 | — | $3K | $3.6M | 1K | 17 |
| 49 | 00042 | — | $3K | $5.2M | 2K | 6 |
| 50 | J9312 | — | $3K | $84.1M | 30K | 85 |
Key Takeaways
- ▸The most expensive Medicaid procedures are specialty drug injections (J-codes) treating rare genetic diseases.
- ▸Spinraza (J2326) costs $92,158 per claim and is administered by only 3 providers.
- ▸Many of the most expensive codes are billed by only 1–3 providers — specialty centers for rare disease treatment.
- ▸Specialty drugs represent a growing share of Medicaid spending despite treating a tiny fraction of beneficiaries.
Source: HHS Medicaid Provider Spending Data (2018–2024) · 227M records