J0185
HCPCS Procedure Code
HCPCS code J0185 is the #1,432 most-billed Medicaid procedure code, with $23.5M in payments across 161K claims from 2018–2024. The national median cost per claim is $125.72. Costs vary widely — the 90th percentile is $297.18 per claim, 2.4× the median.
Total Paid
$23.5M
0.00% of all spending
Total Claims
161K
Providers
159
Avg Cost/Claim
$146
National Cost Distribution
How much do providers bill per claim for J0185? Based on 149 providers billing this code nationally.
Median
$125.72
Average
$153.22
Std Dev
$122.94
Max
$814.84
Percentile Distribution (Cost per Claim)
50% of providers bill between $73.72 and $195.18 per claim for this code.
90% bill between $34.60 and $297.18.
Top 1% bill above $561.45.
About This Procedure
HCPCS code J0185 was billed by 159 providers across 161K claims, totaling $23.5M in Medicaid payments from 2018–2024. This code was used for 96K 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
$125.72
Providers Billing
149
National Spending
$23.5M
Avg/Median Ratio
1.22×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J0185
| # | Provider | Total Paid |
|---|---|---|
| 1 | Dana-farber Cancer Institute, Inc. Boston, MA · General Acute Care Hospital | $2.8M |
| 2 | Hmh Hospitals Corporation Hackensack, NJ · Ambulance | $1.4M |
| 3 | City Of Hope National Medical Center Duarte, CA · General Acute Care Hospital | $1.4M |
| 4 | Yale New Haven Hospital New Haven, CT · General Acute Care Hospital | $1.1M |
| 5 | Arthur G James Cancer Hospital And Research Institute Columbus, OH · Special Hospital | $920K |
| 6 | The General Hospital Corporation Boston, MA · General Acute Care Hospital | $885K |
| 7 | Norton Hospitals Inc Louisville, KY · General Acute Care Hospital | $815K |
| 8 | Memorial Hospital For Cancer And Allied Diseases New York, NY · Pharmacy | $719K |
| 9 | University Of Kentucky Lexington, KY · General Acute Care Hospital | $717K |
| 10 | Umass Memorial Medical Center, Inc. Worcester, MA · General Acute Care Hospital | $553K |
| 11 | Norton Hospitals, Inc Louisville, KY · General Acute Care Hospital | $553K |
| 12 | 1437230034 | $535K |
| 13 | The Cooper Health System Camden, NJ · General Acute Care Hospital | $455K |
| 14 | 1477671535 | $424K |
| 15 | Inova Health Care Services Falls Church, VA · Clinic/Center, Rehabilitation, Substance Use Disorder | $414K |
| 16 | Bakersfield Memorial Hospital Bakersfield, CA · General Acute Care Hospital | $404K |
| 17 | Hartford Hospital Hartford, CT · General Acute Care Hospital | $385K |
| 18 | University Of California Irvine Orange, CA · General Acute Care Hospital | $374K |
| 19 | 1770690695 | $366K |
| 20 | 1548315401 | $362K |
Showing top 20 of 159 providers billing this code