J0791
HCPCS Procedure Code
HCPCS code J0791 is the #1,783 most-billed Medicaid procedure code, with $14.0M in payments across 4K claims from 2018–2024. The national median cost per claim is $3,226.46. Costs vary widely — the 90th percentile is $6,619.47 per claim, 2.1× the median.
Total Paid
$14.0M
0.00% of all spending
Total Claims
4K
Providers
10
Avg Cost/Claim
$4K
National Cost Distribution
How much do providers bill per claim for J0791? Based on 9 providers billing this code nationally.
Median
$3,226.46
Average
$3,403.41
Std Dev
$3,064.80
Max
$9,810.25
Percentile Distribution (Cost per Claim)
50% of providers bill between $614.75 and $3,920.20 per claim for this code.
90% bill between $277.48 and $6,619.47.
Top 1% bill above $9,491.17.
About This Procedure
HCPCS code J0791 was billed by 10 providers across 4K claims, totaling $14.0M in Medicaid payments from 2018–2024. This code was used for 3K 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
$3,226.46
Providers Billing
9
National Spending
$14.0M
Avg/Median Ratio
1.05×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J0791
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1154435824 | $6.0M |
| 2 | State Of Connecticut Farmington, CT · Counselor, Professional | $4.4M |
| 3 | 1144228487 | $2.5M |
| 4 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $378K |
| 5 | Mount Sinai Hospital New York, NY · Ambulance | $372K |
| 6 | Arthur G James Cancer Hospital And Research Institute Columbus, OH · Special Hospital | $255K |
| 7 | Boston Medical Center Corporation Boston, MA · General Acute Care Hospital | $75K |
| 8 | Froedtert Memorial Lutheran Hospital, Inc. Milwaukee, WI · Clinic/Center, Radiology | $33K |
| 9 | 1710277967 | $18K |
| 10 | Childrens Hospital Of Philadelphia Philadelphia, PA · General Acute Care Hospital Children | $0 |
Showing top 10 of 10 providers billing this code