#5654 of 11K

J0280

HCPCS Procedure Code

HCPCS code J0280 is the #5,654 most-billed Medicaid procedure code, with $160K in payments across 56K claims from 2018–2024. The national median cost per claim is $3.04. Costs vary widely — the 90th percentile is $7.20 per claim, 2.4× the median.

Total Paid

$160K

0.00% of all spending

Total Claims

56K

Providers

156

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for J0280? Based on 115 providers billing this code nationally.

Median

$3.04

Average

$4.05

Std Dev

$5.11

Max

$47.55

Percentile Distribution (Cost per Claim)

p10

$0.43

p25

$1.24

Median

$3.04

p75

$5.36

p90

$7.20

p95

$9.58

p99

$15.67

50% of providers bill between $1.24 and $5.36 per claim for this code.

90% bill between $0.43 and $7.20.

Top 1% bill above $15.67.

About This Procedure

HCPCS code J0280 was billed by 156 providers across 56K claims, totaling $160K in Medicaid payments from 2018–2024. This code was used for 50K 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

$3.04

Providers Billing

115

National Spending

$160K

Avg/Median Ratio

1.33×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J0280

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1427043777	$23K	$4.07	1.3× median	Above Median
2	1659387975	$15K	$7.28	2.4× median	Top 10%
3	Hmh Hospitals Corporation Edison, NJ · General Acute Care Hospital	$14K	$5.69	1.9× median	Above 75th
4	1457643306	$12K	$6.76	2.2× median	Above 75th
5	1811214489	$10K	$5.97	2.0× median	Above 75th
6	1578620803	$10K	$2.16	0.7× median	Below Median
7	1225059660	$6K	$2.87	0.9× median	Below Median
8	1831248236	$5K	$4.59	1.5× median	Above Median
9	1376730358	$5K	$4.98	1.6× median	Above Median
10	1356398713	$4K	$5.24	1.7× median	Above Median
11	1487605291	$4K	$3.44	1.1× median	Above Median
12	1942421979	$4K	$5.33	1.8× median	Above Median
13	1538584495	$4K	$5.73	1.9× median	Above 75th
14	1851315105	$3K	$3.39	1.1× median	Above Median
15	1790297455	$3K	$7.38	2.4× median	Top 10%
16	Trinitas Regional Medical Center Elizabeth, NJ · General Acute Care Hospital	$3K	$10.45	3.4× median	Top 10%
17	Nyu Langone Hospitals New York, NY · Clinic/Center, Oncology	$3K	$7.09	2.3× median	Above 75th
18	1073567418	$2K	$1.06	0.3× median	Below Median
19	1215445127	$2K	$2.52	0.8× median	Below Median
20	1568647501	$2K	$1.36	0.4× median	Below Median

Showing top 20 of 156 providers billing this code

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