#3567 of 11K

J1095

HCPCS Procedure Code

HCPCS code J1095 is the #3,567 most-billed Medicaid procedure code, with $1.5M in payments across 6K claims from 2018–2024. The national median cost per claim is $237.84.

Total Paid

$1.5M

0.00% of all spending

Total Claims

Providers

Avg Cost/Claim

$233

National Cost Distribution

How much do providers bill per claim for J1095? Based on 23 providers billing this code nationally.

Median

$237.84

Average

$196.50

Std Dev

$109.06

Max

$426.09

Percentile Distribution (Cost per Claim)

p10

$26.16

p25

$116.43

Median

$237.84

p75

$258.61

p90

$281.57

p95

$287.06

p99

$395.56

50% of providers bill between $116.43 and $258.61 per claim for this code.

90% bill between $26.16 and $281.57.

Top 1% bill above $395.56.

About This Procedure

HCPCS code J1095 was billed by 26 providers across 6K claims, totaling $1.5M in Medicaid payments from 2018–2024. This code was used for 5K 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

$237.84

Providers Billing

National Spending

$1.5M

Avg/Median Ratio

0.83×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J1095

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1902834922	$175K	$256.43	1.1× median	Above Median
2	1407120512	$172K	$269.00	1.1× median	Above 75th
3	1104199413	$169K	$237.84	1.0× median	Below Median
4	1306119615	$165K	$249.96	1.1× median	Above Median
5	1538432844	$164K	$260.78	1.1× median	Above 75th
6	1528000817	$136K	$246.72	1.0× median	Above Median
7	1417985102	$96K	$250.50	1.1× median	Above Median
8	1275569121	$90K	$229.36	1.0× median	Below Median
9	1558305086	$79K	$284.72	1.2× median	Top 10%
10	1821361130	$73K	$254.63	1.1× median	Above Median
11	1861089666	$47K	$220.90	0.9× median	Below Median
12	1700828423	$32K	$226.58	1.0× median	Below Median
13	1497727093	$25K	$287.32	1.2× median	Top 10%
14	1497171714	$22K	$426.09	1.8× median	Top 1%
15	1093778052	$20K	$99.33	0.4× median	Below Median
16	1023063187	$8K	$180.00	0.8× median	Below Median
17	1639386659	$7K	$133.53	0.6× median	Below Median
18	1720278047	$5K	$267.71	1.1× median	Above 75th
19	1164472031	$2K	$7.23	0.0× median	Below Median
20	1780901520	$1K	$68.88	0.3× median	Below Median

Showing top 20 of 26 providers billing this code

Related Procedures

J1100$58.7M J1096$1.1M J1097$791K J1094$66K J1105$915

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