#5246 of 11K

J1380

HCPCS Procedure Code

HCPCS code J1380 is the #5,246 most-billed Medicaid procedure code, with $251K in payments across 24K claims from 2018–2024. The national median cost per claim is $8.14. Costs vary widely — the 90th percentile is $22.26 per claim, 2.7× the median.

Total Paid

$251K

0.00% of all spending

Total Claims

24K

Providers

Avg Cost/Claim

$11

National Cost Distribution

How much do providers bill per claim for J1380? Based on 21 providers billing this code nationally.

Median

$8.14

Average

$10.98

Std Dev

$10.90

Max

$43.32

Percentile Distribution (Cost per Claim)

p10

$0.45

p25

$1.97

Median

$8.14

p75

$16.37

p90

$22.26

p95

$26.72

p99

$40.00

50% of providers bill between $1.97 and $16.37 per claim for this code.

90% bill between $0.45 and $22.26.

Top 1% bill above $40.00.

About This Procedure

HCPCS code J1380 was billed by 27 providers across 24K claims, totaling $251K in Medicaid payments from 2018–2024. This code was used for 17K 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

$8.14

Providers Billing

National Spending

$251K

Avg/Median Ratio

1.35×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J1380

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1306898432	$59K	$12.23	1.5× median	Above Median
2	City & County Of San Francisco San Francisco, CA · Case Manager/Care Coordinator	$55K	$43.32	5.3× median	Top 1%
3	1346643236	$46K	$13.02	1.6× median	Above Median
4	1104227404	$31K	$18.62	2.3× median	Above 75th
5	1710945969	$23K	$26.72	3.3× median	Top 10%
6	1790720910	$16K	$13.81	1.7× median	Above Median
7	1194135657	$10K	$22.26	2.7× median	Above 75th
8	Mount Sinai Hospital New York, NY · Ambulance	$3K	$3.99	0.5× median	Below Median
9	1013933167	$2K	$20.06	2.5× median	Above 75th
10	1326735929	$1K	$7.30	0.9× median	Below Median
11	1366441370	$888	$1.97	0.2× median	Below Median
12	1083661409	$773	$8.14	1.0× median	Below Median
13	County Of Santa Clara San Jose, CA · Clinic/Center Federally Qualified Health Center (FQHC)	$566	$9.43	1.2× median	Above Median
14	1184610248	$400	$4.82	0.6× median	Below Median
15	1447297379	$269	$0.70	0.1× median	Below Median
16	Dayton Osteopathic Hospital Dayton, OH · General Acute Care Hospital	$245	$16.37	2.0× median	Above Median
17	1962040246	$189	$0.70	0.1× median	Below Median
18	1215095237	$166	$6.63	0.8× median	Below Median
19	1295108025	$38	$0.45	0.1× median	Below Median
20	1861893844	$23	$0.01	0.0× median	Below Median

Showing top 20 of 27 providers billing this code

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