J0295
HCPCS Procedure Code
HCPCS code J0295 is the #4,565 most-billed Medicaid procedure code, with $511K in payments across 192K claims from 2018–2024. The national median cost per claim is $1.11. Costs vary widely — the 90th percentile is $9.88 per claim, 8.9× the median.
Total Paid
$511K
0.00% of all spending
Total Claims
192K
Providers
299
Avg Cost/Claim
$3
National Cost Distribution
How much do providers bill per claim for J0295? Based on 206 providers billing this code nationally.
Median
$1.11
Average
$6.66
Std Dev
$32.52
Max
$440.86
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.27 and $3.74 per claim for this code.
90% bill between $0.03 and $9.88.
Top 1% bill above $63.86.
About This Procedure
HCPCS code J0295 was billed by 299 providers across 192K claims, totaling $511K in Medicaid payments from 2018–2024. This code was used for 93K 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
$1.11
Providers Billing
206
National Spending
$511K
Avg/Median Ratio
6.00×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J0295
| # | Provider | Total Paid |
|---|---|---|
| 1 | University Of Utah Salt Lake City, UT · Clinic/Center, Dental | $91K |
| 2 | Upmc Children's Hospital Of Pittsburgh Pittsburgh, PA · Clinic/Center | $55K |
| 3 | Charleston Area Medical Center Inc Charleston, WV · General Acute Care Hospital | $48K |
| 4 | 1548393127 | $28K |
| 5 | Children's Hospital Corporation Boston, MA · Clinic/Center | $18K |
| 6 | University Of Kentucky Lexington, KY · General Acute Care Hospital | $17K |
| 7 | Norton Hospitals, Inc Louisville, KY · General Acute Care Hospital | $17K |
| 8 | Norton Hospitals Inc Louisville, KY · General Acute Care Hospital | $16K |
| 9 | West Virginia University Hospitals, Inc Morgantown, WV · Clinical Medical Laboratory | $15K |
| 10 | Unm Hospital Albuquerque, NM · General Acute Care Hospital | $14K |
| 11 | Scottish Rite Children's Medical Center Atlanta, GA · Pediatrics Pediatric Hematology-Oncology | $13K |
| 12 | 1134194038 | $11K |
| 13 | 1124098421 | $10K |
| 14 | University Hospital Newark, NJ · General Acute Care Hospital | $10K |
| 15 | Umass Memorial Medical Center, Inc. Worcester, MA · General Acute Care Hospital | $9K |
| 16 | The General Hospital Corporation Boston, MA · General Acute Care Hospital | $7K |
| 17 | Boston Medical Center Corporation Boston, MA · General Acute Care Hospital | $6K |
| 18 | Long Island Jewish Medical Center New Hyde Park, NY · General Acute Care Hospital | $5K |
| 19 | North Shore Medical Center, Inc. Salem, MA · General Acute Care Hospital | $5K |
| 20 | Presbyterian Healthcare Services Albuquerque, NM · Emergency Medicine | $5K |
Showing top 20 of 299 providers billing this code