Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

#3725 of 11K

J2274

HCPCS Procedure Code

HCPCS code J2274 is the #3,725 most-billed Medicaid procedure code, with $1.3M in payments across 156K claims from 2018–2024. The national median cost per claim is $2.97. Costs vary widely — the 90th percentile is $19.26 per claim, 6.5× the median.

Total Paid

$1.3M

0.00% of all spending

Total Claims

156K

Providers

241

Avg Cost/Claim

$8

National Cost Distribution

How much do providers bill per claim for J2274? Based on 181 providers billing this code nationally.

Median

$2.97

Average

$11.41

Std Dev

$49.15

Max

$641.99

Percentile Distribution (Cost per Claim)

p10
$0.09
p25
$0.46
Median
$2.97
p75
$9.96
p90
$19.26
p95
$30.93
p99
$91.04

50% of providers bill between $0.46 and $9.96 per claim for this code.

90% bill between $0.09 and $19.26.

Top 1% bill above $91.04.

About This Procedure

HCPCS code J2274 was billed by 241 providers across 156K claims, totaling $1.3M in Medicaid payments from 2018–2024. This code was used for 126K 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

$2.97

Providers Billing

181

National Spending

$1.3M

Avg/Median Ratio

3.84×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for J2274

#ProviderTotal Paid
11336243393$579K
21770528994$72K
31710958228$69K
41114367497$52K
51568469997$36K
6Medical University Hospital Authority

Charleston, SC · General Acute Care Hospital

$36K
71750332565$35K
81639124142$25K
91205882503$23K
101902803315$23K
111427055839$21K
12Bluefield Hospital Company Llc

Bluefield, WV · General Acute Care Hospital

$17K
13Children's Hospital Medical Center Of Akron

Akron, OH · General Acute Care Hospital Children

$17K
14Children's Hospital Of Wisconsin, Inc.

Milwaukee, WI · Dentist, Pediatric Dentistry

$17K
151063484483$15K
16Norton Hospitals, Inc

Louisville, KY · General Acute Care Hospital

$14K
171285688697$13K
181790722346$12K
191780655670$11K
20Norton Hospitals Inc

Louisville, KY · General Acute Care Hospital

$9K

Showing top 20 of 241 providers billing this code