J1325
HCPCS Procedure Code
HCPCS code J1325 is the #2,387 most-billed Medicaid procedure code, with $6.2M in payments across 10K claims from 2018–2024. The national median cost per claim is $732.53. Costs vary widely — the 90th percentile is $2,116.00 per claim, 2.9× the median.
Total Paid
$6.2M
0.00% of all spending
Total Claims
10K
Providers
5
Avg Cost/Claim
$636
National Cost Distribution
How much do providers bill per claim for J1325? Based on 5 providers billing this code nationally.
Median
$732.53
Average
$1,157.81
Std Dev
$860.11
Max
$2,446.33
Percentile Distribution (Cost per Claim)
50% of providers bill between $606.21 and $1,620.51 per claim for this code.
90% bill between $472.55 and $2,116.00.
Top 1% bill above $2,413.30.
About This Procedure
HCPCS code J1325 was billed by 5 providers across 10K claims, totaling $6.2M in Medicaid payments from 2018–2024. This code was used for 4K 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
$732.53
Providers Billing
5
National Spending
$6.2M
Avg/Median Ratio
1.58×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for J1325
| # | Provider | Total Paid |
|---|---|---|
| 1 | Accredo Health Group Inc Warrendale, PA · Pharmacy, Community/Retail Pharmacy | $4.9M |
| 2 | Accredo Health Group Inc Orlando, FL · Pharmacy Specialty Pharmacy | $1.0M |
| 3 | 1952359150 | $166K |
| 4 | 1710933007 | $32K |
| 5 | Accredo Health Group Inc Memphis, TN · Pharmacy | $23K |
Showing top 5 of 5 providers billing this code