J1245
HCPCS Procedure Code
HCPCS code J1245 is the #5,117 most-billed Medicaid procedure code, with $286K in payments across 55K claims from 2018–2024. The national median cost per claim is $3.76. Costs vary widely — the 90th percentile is $10.75 per claim, 2.9× the median.
Total Paid
$286K
0.00% of all spending
Total Claims
55K
Providers
134
Avg Cost/Claim
$5
National Cost Distribution
How much do providers bill per claim for J1245? Based on 102 providers billing this code nationally.
Median
$3.76
Average
$9.80
Std Dev
$35.12
Max
$341.06
Percentile Distribution (Cost per Claim)
50% of providers bill between $1.12 and $7.05 per claim for this code.
90% bill between $0.40 and $10.75.
Top 1% bill above $81.09.
About This Procedure
HCPCS code J1245 was billed by 134 providers across 55K claims, totaling $286K in Medicaid payments from 2018–2024. This code was used for 49K 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
$3.76
Providers Billing
102
National Spending
$286K
Avg/Median Ratio
2.61×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J1245
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1588658199 | $34K |
| 2 | 1659387975 | $27K |
| 3 | 1811214489 | $21K |
| 4 | 1336147859 | $19K |
| 5 | Hmh Hospitals Corporation Edison, NJ · General Acute Care Hospital | $16K |
| 6 | 1578620803 | $14K |
| 7 | 1457643306 | $13K |
| 8 | 1710962204 | $12K |
| 9 | 1215445127 | $11K |
| 10 | 1538584495 | $11K |
| 11 | 1861615452 | $9K |
| 12 | 1225059660 | $9K |
| 13 | 1851315105 | $6K |
| 14 | Trinitas Regional Medical Center Elizabeth, NJ · General Acute Care Hospital | $6K |
| 15 | 1982625885 | $6K |
| 16 | 1790297455 | $6K |
| 17 | 1386643294 | $5K |
| 18 | 1396033379 | $5K |
| 19 | 1437257870 | $4K |
| 20 | 1982752747 | $4K |
Showing top 20 of 134 providers billing this code