J1200
HCPCS Procedure Code
HCPCS code J1200 is the #1,588 most-billed Medicaid procedure code, with $18.4M in payments across 5.9M claims from 2018–2024. The national median cost per claim is $0.60. Costs vary widely — the 90th percentile is $6.01 per claim, 10.0× the median.
Total Paid
$18.4M
0.00% of all spending
Total Claims
5.9M
Providers
3K
Avg Cost/Claim
$3
National Cost Distribution
How much do providers bill per claim for J1200? Based on 3K providers billing this code nationally.
Median
$0.60
Average
$4.15
Std Dev
$25.82
Max
$781.57
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.10 and $1.99 per claim for this code.
90% bill between $0.02 and $6.01.
Top 1% bill above $54.44.
About This Procedure
HCPCS code J1200 was billed by 3K providers across 5.9M claims, totaling $18.4M in Medicaid payments from 2018–2024. This code was used for 4.5M 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
$0.60
Providers Billing
3K
National Spending
$18.4M
Avg/Median Ratio
6.92×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J1200
| # | Provider | Total Paid |
|---|---|---|
| 1 | University Of Utah Salt Lake City, UT · Clinic/Center, Dental | $1.6M |
| 2 | Rhode Island Hospital Providence, RI · General Acute Care Hospital | $811K |
| 3 | 1952333205 | $708K |
| 4 | Keck Medical Center Of Usc Los Angeles, CA · General Acute Care Hospital | $529K |
| 5 | Vhs Childrens Hospital Of Michigan Inc Detroit, MI · Clinic/Center, Ambulatory Surgical | $409K |
| 6 | 1275651515 | $384K |
| 7 | 1568570109 | $355K |
| 8 | 1376513754 | $314K |
| 9 | 1235196510 | $277K |
| 10 | 1952546616 | $262K |
| 11 | Umass Memorial Medical Center, Inc. Worcester, MA · General Acute Care Hospital | $255K |
| 12 | The General Hospital Corporation Boston, MA · General Acute Care Hospital | $242K |
| 13 | 1295747277 | $227K |
| 14 | Charleston Area Medical Center Inc Charleston, WV · General Acute Care Hospital | $195K |
| 15 | 1699887430 | $194K |
| 16 | 1700801909 | $184K |
| 17 | 1255644357 | $183K |
| 18 | University Medical Center, Inc Louisville, KY · Student in an Organized Health Care Education/Training Program | $177K |
| 19 | 1457409674 | $174K |
| 20 | 1073518007 | $160K |
Showing top 20 of 3K providers billing this code