#3322 of 11K

J0177

HCPCS Procedure Code

HCPCS code J0177 is the #3,322 most-billed Medicaid procedure code, with $1.9M in payments across 3K claims from 2018–2024. The national median cost per claim is $869.28. Costs vary widely — the 90th percentile is $2,704.40 per claim, 3.1× the median.

Total Paid

$1.9M

0.00% of all spending

Total Claims

Providers

Avg Cost/Claim

$728

National Cost Distribution

How much do providers bill per claim for J0177? Based on 15 providers billing this code nationally.

Median

$869.28

Average

$1,276.75

Std Dev

$952.38

Max

$3,401.81

Percentile Distribution (Cost per Claim)

p10

$513.88

p25

$554.67

Median

$869.28

p75

$1,674.69

p90

$2,704.40

p95

$3,003.27

p99

$3,322.10

50% of providers bill between $554.67 and $1,674.69 per claim for this code.

90% bill between $513.88 and $2,704.40.

Top 1% bill above $3,322.10.

About This Procedure

HCPCS code J0177 was billed by 16 providers across 3K claims, totaling $1.9M in Medicaid payments from 2018–2024. This code was used for 2K 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

$869.28

Providers Billing

National Spending

$1.9M

Avg/Median Ratio

1.47×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J0177

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1164578894	$585K	$543.07	0.6× median	Below Median
2	1225001654	$343K	$708.17	0.8× median	Below Median
3	The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital	$286K	$1,694.19	1.9× median	Above 75th
4	1447331087	$150K	$869.28	1.0× median	Above Median
5	1548874936	$144K	$496.35	0.6× median	Below Median
6	1114099835	$93K	$1,341.11	1.5× median	Above Median
7	1720203862	$74K	$2,832.47	3.3× median	Top 10%
8	1093748071	$73K	$478.25	0.6× median	Below Median
9	1902800758	$51K	$3,401.81	3.9× median	Top 1%
10	Southern California Permanente Medical Group Panorama City, CA · Health Maintenance Organization	$45K	$2,512.29	2.9× median	Above 75th
11	1023076593	$31K	$596.71	0.7× median	Below Median
12	1083757322	$23K	$1,655.20	1.9× median	Above Median
13	1316329733	$21K	$915.98	1.1× median	Above Median
14	1750398863	$9K	$540.18	0.6× median	Below Median
15	1134164023	$8K	$566.27	0.7× median	Below Median
16	1962003418	$0	$0.00	0.0× median	Below Median

Showing top 16 of 16 providers billing this code

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