#2078 of 11K

J0878

HCPCS Procedure Code

HCPCS code J0878 is the #2,078 most-billed Medicaid procedure code, with $9.4M in payments across 56K claims from 2018–2024. The national median cost per claim is $130.03. Costs vary widely — the 90th percentile is $503.05 per claim, 3.9× the median.

Total Paid

$9.4M

0.00% of all spending

Total Claims

56K

Providers

Avg Cost/Claim

$168

National Cost Distribution

How much do providers bill per claim for J0878? Based on 34 providers billing this code nationally.

Median

$130.03

Average

$222.25

Std Dev

$280.85

Max

$1,433.96

Percentile Distribution (Cost per Claim)

p10

$22.77

p25

$51.79

Median

$130.03

p75

$273.40

p90

$503.05

p95

$682.40

p99

$1,195.44

50% of providers bill between $51.79 and $273.40 per claim for this code.

90% bill between $22.77 and $503.05.

Top 1% bill above $1,195.44.

About This Procedure

HCPCS code J0878 was billed by 35 providers across 56K claims, totaling $9.4M in Medicaid payments from 2018–2024. This code was used for 7K 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

$130.03

Providers Billing

National Spending

$9.4M

Avg/Median Ratio

1.71×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for J0878

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1902182637	$3.2M	$426.35	3.3× median	Above 75th
2	1881915031	$1.1M	$1,433.96	11.0× median	Top 1%
3	1255336517	$1.1M	$164.53	1.3× median	Above Median
4	1639403330	$768K	$54.65	0.4× median	Below Median
5	1114099488	$610K	$71.95	0.6× median	Below Median
6	1518036458	$542K	$302.39	2.3× median	Above 75th
7	1144560434	$360K	$250.17	1.9× median	Above Median
8	1568474716	$305K	$711.18	5.5× median	Top 10%
9	Best Option Healthcare Puerto Rico Llc San Juan, PR · Pharmacy Home Infusion Therapy Pharmacy	$302K	$535.92	4.1× median	Top 10%
10	1619970845	$267K	$666.91	5.1× median	Top 10%
11	1508850926	$202K	$53.87	0.4× median	Below Median
12	1750484903	$165K	$184.48	1.4× median	Above Median
13	Newyork-presbyterian-queens Flushing, NY · General Acute Care Hospital	$105K	$51.02	0.4× median	Below Median
14	1760575583	$85K	$331.19	2.5× median	Above 75th
15	1912212481	$75K	$35.40	0.3× median	Below Median
16	1619478047	$38K	$20.02	0.2× median	Below Median
17	Optum Infusion Services 308 Llc Chandler, AZ · Pharmacy Home Infusion Therapy Pharmacy	$33K	$29.18	0.2× median	Below Median
18	Norton Hospitals Inc Louisville, KY · General Acute Care Hospital	$27K	$277.74	2.1× median	Above 75th
19	1467488148	$24K	$188.75	1.5× median	Above Median
20	1013919240	$19K	$143.49	1.1× median	Above Median

Showing top 20 of 35 providers billing this code

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