J1815
HCPCS Procedure Code
HCPCS code J1815 is the #2,240 most-billed Medicaid procedure code, with $7.5M in payments across 1.7M claims from 2018–2024. The national median cost per claim is $1.76. Costs vary widely — the 90th percentile is $20.17 per claim, 11.5× the median.
Total Paid
$7.5M
0.00% of all spending
Total Claims
1.7M
Providers
1,063
Avg Cost/Claim
$4
National Cost Distribution
How much do providers bill per claim for J1815? Based on 860 providers billing this code nationally.
Median
$1.76
Average
$11.21
Std Dev
$43.38
Max
$750.49
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.22 and $7.67 per claim for this code.
90% bill between $0.04 and $20.17.
Top 1% bill above $160.61.
About This Procedure
HCPCS code J1815 was billed by 1,063 providers across 1.7M claims, totaling $7.5M in Medicaid payments from 2018–2024. This code was used for 762K 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
$1.76
Providers Billing
860
National Spending
$7.5M
Avg/Median Ratio
6.37×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J1815
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1639358047 | $317K |
| 2 | Palomar Health Escondido, CA · General Acute Care Hospital | $312K |
| 3 | University Of Utah Salt Lake City, UT · Clinic/Center, Dental | $258K |
| 4 | 1699756221 | $232K |
| 5 | Charleston Area Medical Center Inc Charleston, WV · General Acute Care Hospital | $231K |
| 6 | Rhode Island Hospital Providence, RI · General Acute Care Hospital | $225K |
| 7 | 1457382483 | $212K |
| 8 | 1588663769 | $172K |
| 9 | Alameda Health System Oakland, CA · General Acute Care Hospital | $144K |
| 10 | 1366436073 | $128K |
| 11 | Boston Medical Center Corporation Boston, MA · General Acute Care Hospital | $127K |
| 12 | Regents Of The University Of California Sacramento, CA · General Acute Care Hospital | $122K |
| 13 | 1891938122 | $116K |
| 14 | 1821147786 | $110K |
| 15 | Umass Memorial Medical Center, Inc. Worcester, MA · General Acute Care Hospital | $106K |
| 16 | 1225033020 | $95K |
| 17 | 1114367497 | $93K |
| 18 | 1518951300 | $85K |
| 19 | 1518018191 | $80K |
| 20 | The Miriam Hospital Providence, RI · General Acute Care Hospital | $77K |
Showing top 20 of 1,063 providers billing this code