J1790
HCPCS Procedure Code
HCPCS code J1790 is the #3,949 most-billed Medicaid procedure code, with $985K in payments across 340K claims from 2018–2024. The national median cost per claim is $0.37. Costs vary widely — the 90th percentile is $8.14 per claim, 22.0× the median.
Total Paid
$985K
0.00% of all spending
Total Claims
340K
Providers
618
Avg Cost/Claim
$3
National Cost Distribution
How much do providers bill per claim for J1790? Based on 410 providers billing this code nationally.
Median
$0.37
Average
$2.98
Std Dev
$11.94
Max
$229.21
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.05 and $2.99 per claim for this code.
90% bill between $0.01 and $8.14.
Top 1% bill above $18.84.
About This Procedure
HCPCS code J1790 was billed by 618 providers across 340K claims, totaling $985K in Medicaid payments from 2018–2024. This code was used for 291K 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
$0.37
Providers Billing
410
National Spending
$985K
Avg/Median Ratio
8.05×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J1790
| # | Provider | Total Paid |
|---|---|---|
| 1 | University Of Utah Salt Lake City, UT · Clinic/Center, Dental | $512K |
| 2 | Uofl Health-louisville Inc Louisville, KY · Psychiatric Hospital | $39K |
| 3 | University Medical Center, Inc Louisville, KY · Student in an Organized Health Care Education/Training Program | $23K |
| 4 | 1588663769 | $17K |
| 5 | 1952348047 | $16K |
| 6 | 1720537178 | $15K |
| 7 | University Of Kentucky Lexington, KY · General Acute Care Hospital | $15K |
| 8 | Antelope Valley Health Care District Lancaster, CA · General Acute Care Hospital | $15K |
| 9 | Providence Health & Services Washington Anchorage, AK · General Acute Care Hospital | $13K |
| 10 | 1548393127 | $13K |
| 11 | Riverside University Health Systems - Medical Center Moreno Valley, CA · General Acute Care Hospital | $12K |
| 12 | Regents Of The University Of California Sacramento, CA · General Acute Care Hospital | $12K |
| 13 | Stanford Health Care Stanford, CA · General Acute Care Hospital | $11K |
| 14 | 1730264128 | $11K |
| 15 | Unm Hospital Albuquerque, NM · General Acute Care Hospital | $11K |
| 16 | 1447393152 | $10K |
| 17 | 1265539498 | $10K |
| 18 | 1124078696 | $8K |
| 19 | 1417947490 | $8K |
| 20 | St Elizabeth Medical Center, Inc Edgewood, KY · Portable X-Ray and/or Other Portable Diagnostic Imaging Supplier | $7K |
Showing top 20 of 618 providers billing this code