#4076 of 11K

J0153

HCPCS Procedure Code

HCPCS code J0153 is the #4,076 most-billed Medicaid procedure code, with $868K in payments across 46K claims from 2018–2024. The national median cost per claim is $10.08. Costs vary widely — the 90th percentile is $53.08 per claim, 5.3× the median.

Total Paid

$868K

0.00% of all spending

Total Claims

46K

Providers

150

Avg Cost/Claim

$19

National Cost Distribution

How much do providers bill per claim for J0153? Based on 125 providers billing this code nationally.

Median

$10.08

Average

$19.53

Std Dev

$29.80

Max

$212.95

Percentile Distribution (Cost per Claim)

p10

$1.32

p25

$3.40

Median

$10.08

p75

$21.68

p90

$53.08

p95

$68.03

p99

$141.17

50% of providers bill between $3.40 and $21.68 per claim for this code.

90% bill between $1.32 and $53.08.

Top 1% bill above $141.17.

About This Procedure

HCPCS code J0153 was billed by 150 providers across 46K claims, totaling $868K in Medicaid payments from 2018–2024. This code was used for 39K 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

$10.08

Providers Billing

125

National Spending

$868K

Avg/Median Ratio

1.94×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for J0153

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1184680480	$169K	$133.86	13.3× median	Top 10%
2	1932202959	$73K	$81.89	8.1× median	Top 10%
3	1477532588	$72K	$29.26	2.9× median	Above 75th
4	1699857706	$66K	$37.91	3.8× median	Above 75th
5	1689752032	$45K	$11.85	1.2× median	Above Median
6	1063886323	$36K	$18.37	1.8× median	Above Median
7	1003281452	$34K	$58.91	5.8× median	Top 10%
8	1124295738	$29K	$37.10	3.7× median	Above 75th
9	1265590863	$29K	$53.99	5.4× median	Top 10%
10	1275630527	$27K	$63.09	6.3× median	Top 10%
11	1487771812	$26K	$56.03	5.6× median	Top 10%
12	1730114851	$24K	$12.02	1.2× median	Above Median
13	1619038247	$21K	$143.48	14.2× median	Top 1%
14	1649504143	$19K	$9.85	1.0× median	Below Median
15	Charleston Area Medical Center Inc Charleston, WV · General Acute Care Hospital	$17K	$69.82	6.9× median	Top 10%
16	1437424330	$14K	$28.59	2.8× median	Above 75th
17	1740225838	$13K	$3.71	0.4× median	Below Median
18	1164415899	$12K	$7.72	0.8× median	Below Median
19	1477796464	$10K	$97.44	9.7× median	Top 10%
20	Optum Medical Care Of New Jersey Pc Secaucus, NJ · Durable Medical Equipment & Medical Supplies	$8K	$2.50	0.2× median	Below Median

Showing top 20 of 150 providers billing this code

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