J1805
HCPCS Procedure Code
HCPCS code J1805 is the #6,860 most-billed Medicaid procedure code, with $39K in payments across 18K claims from 2018–2024. The national median cost per claim is $0.30. Costs vary widely — the 90th percentile is $6.73 per claim, 22.4× the median.
Total Paid
$39K
0.00% of all spending
Total Claims
18K
Providers
66
Avg Cost/Claim
$2
National Cost Distribution
How much do providers bill per claim for J1805? Based on 38 providers billing this code nationally.
Median
$0.30
Average
$2.54
Std Dev
$5.12
Max
$23.00
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.10 and $2.04 per claim for this code.
90% bill between $0.03 and $6.73.
Top 1% bill above $21.27.
About This Procedure
HCPCS code J1805 was billed by 66 providers across 18K claims, totaling $39K in Medicaid payments from 2018–2024. This code was used for 13K 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
$0.30
Providers Billing
38
National Spending
$39K
Avg/Median Ratio
8.47×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J1805
| # | Provider | Total Paid |
|---|---|---|
| 1 | Seventh-day Adventists Loma Linda University Medical Center Loma Linda, CA · General Acute Care Hospital | $11K |
| 2 | 1427055821 | $10K |
| 3 | Owensboro Health Inc Owensboro, KY · General Acute Care Hospital | $7K |
| 4 | Summa Health System Akron, OH · General Acute Care Hospital | $5K |
| 5 | Unm Hospital Albuquerque, NM · General Acute Care Hospital | $2K |
| 6 | University Of Kentucky Lexington, KY · General Acute Care Hospital | $951 |
| 7 | Uofl Health-louisville Inc Louisville, KY · Psychiatric Hospital | $720 |
| 8 | University Medical Center, Inc Louisville, KY · Student in an Organized Health Care Education/Training Program | $531 |
| 9 | The Metrohealth System Cleveland, OH · General Acute Care Hospital | $442 |
| 10 | Keck Medical Center Of Usc Los Angeles, CA · General Acute Care Hospital | $314 |
| 11 | Riverside University Health Systems - Medical Center Moreno Valley, CA · General Acute Care Hospital | $261 |
| 12 | Ohiohealth Corporation Columbus, OH · General Acute Care Hospital | $237 |
| 13 | 1760764849 | $236 |
| 14 | Dayton Osteopathic Hospital Dayton, OH · General Acute Care Hospital | $190 |
| 15 | The General Hospital Corporation Boston, MA · General Acute Care Hospital | $139 |
| 16 | University Hospitals Cleveland Medical Center Cleveland, OH · General Acute Care Hospital | $114 |
| 17 | Yale New Haven Hospital New Haven, CT · General Acute Care Hospital | $114 |
| 18 | Ohio State University Hospitals Columbus, OH · General Acute Care Hospital | $103 |
| 19 | Nyu Langone Hospitals New York, NY · Clinic/Center, Oncology | $76 |
| 20 | 1538244918 | $59 |
Showing top 20 of 66 providers billing this code