#1045 of 11K

J0717

HCPCS Procedure Code

HCPCS code J0717 is the #1,045 most-billed Medicaid procedure code, with $46.2M in payments across 22K claims from 2018–2024. The national median cost per claim is $1,144.80. Costs vary widely — the 90th percentile is $2,562.96 per claim, 2.2× the median.

Total Paid

$46.2M

0.00% of all spending

Total Claims

22K

Providers

Avg Cost/Claim

$2K

National Cost Distribution

How much do providers bill per claim for J0717? Based on 29 providers billing this code nationally.

Median

$1,144.80

Average

$1,208.67

Std Dev

$965.09

Max

$3,717.03

Percentile Distribution (Cost per Claim)

p10

$215.99

p25

$363.35

Median

$1,144.80

p75

$1,726.42

p90

$2,562.96

p95

$2,818.65

p99

$3,476.89

50% of providers bill between $363.35 and $1,726.42 per claim for this code.

90% bill between $215.99 and $2,562.96.

Top 1% bill above $3,476.89.

About This Procedure

HCPCS code J0717 was billed by 31 providers across 22K claims, totaling $46.2M in Medicaid payments from 2018–2024. This code was used for 19K 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

$1,144.80

Providers Billing

National Spending

$46.2M

Avg/Median Ratio

1.06×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J0717

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1477914232	$16.2M	$3,717.03	3.2× median	Top 1%
2	1891930673	$13.4M	$2,757.55	2.4× median	Top 10%
3	1174822902	$6.9M	$1,821.01	1.6× median	Above 75th
4	1306334255	$2.5M	$1,310.14	1.1× median	Above Median
5	1609812544	$1.0M	$1,316.50	1.1× median	Above Median
6	1235671389	$909K	$2,859.38	2.5× median	Top 10%
7	1528248242	$862K	$1,134.14	1.0× median	Below Median
8	1447308168	$765K	$1,726.42	1.5× median	Above Median
9	1164088704	$702K	$1,967.05	1.7× median	Above 75th
10	1437199882	$528K	$588.98	0.5× median	Below Median
11	Arthritis & Rheumatology Associates Of South Jersey Pc Vineland, NJ · Internal Medicine Rheumatology	$527K	$1,412.67	1.2× median	Above Median
12	1386199446	$516K	$1,591.57	1.4× median	Above Median
13	1588875512	$480K	$2,514.31	2.2× median	Above 75th
14	1710943881	$191K	$366.85	0.3× median	Below Median
15	1821495656	$150K	$2,208.92	1.9× median	Above 75th
16	1578969465	$132K	$1,144.80	1.0× median	Below Median
17	1194253872	$75K	$92.13	0.1× median	Below Median
18	1427509140	$51K	$363.35	0.3× median	Below Median
19	1518272392	$50K	$273.65	0.2× median	Below Median
20	1346588852	$41K	$338.08	0.3× median	Below Median

Showing top 20 of 31 providers billing this code

Related Procedures

J0716$66K J0725$22K J0720$3K J0713$3K J0715$0

← All procedures Top providers →