#591 of 11K

J2315

HCPCS Procedure Code

HCPCS code J2315 is the #591 most-billed Medicaid procedure code, with $136.7M in payments across 160K claims from 2018–2024. The national median cost per claim is $1,045.36.

Total Paid

$136.7M

0.01% of all spending

Total Claims

160K

Providers

239

Avg Cost/Claim

$855

National Cost Distribution

How much do providers bill per claim for J2315? Based on 205 providers billing this code nationally.

Median

$1,045.36

Average

$806.75

Std Dev

$529.46

Max

$2,485.38

Percentile Distribution (Cost per Claim)

p10

$0.33

p25

$176.79

Median

$1,045.36

p75

$1,225.08

p90

$1,296.29

p95

$1,366.83

p99

$1,501.01

50% of providers bill between $176.79 and $1,225.08 per claim for this code.

90% bill between $0.33 and $1,296.29.

Top 1% bill above $1,501.01.

About This Procedure

HCPCS code J2315 was billed by 239 providers across 160K claims, totaling $136.7M in Medicaid payments from 2018–2024. This code was used for 137K 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

$1,045.36

Providers Billing

205

National Spending

$136.7M

Avg/Median Ratio

0.77×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J2315

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1235564188	$27.3M	$1,017.15	1.0× median	Below Median
2	Orsini Pharmaceutical Services Llc Elk Grove Village, IL · Pharmacy Specialty Pharmacy	$9.2M	$1,190.80	1.1× median	Above Median
3	1538147202	$4.9M	$1,225.08	1.2× median	Above 75th
4	1083045140	$4.4M	$1,295.36	1.2× median	Above 75th
5	1962514877	$4.2M	$1,285.57	1.2× median	Above 75th
6	1598135451	$4.1M	$1,072.06	1.0× median	Above Median
7	1720440464	$4.1M	$1,148.90	1.1× median	Above Median
8	1790847101	$3.8M	$905.48	0.9× median	Below Median
9	1982018610	$3.8M	$1,260.71	1.2× median	Above 75th
10	1942458567	$3.6M	$1,154.71	1.1× median	Above Median
11	1396076147	$3.2M	$1,234.58	1.2× median	Above 75th
12	1902431653	$3.1M	$1,366.43	1.3× median	Top 10%
13	Procare Pharmacy Direct, Llc. Monroeville, PA · Pharmacy, Community/Retail Pharmacy	$2.9M	$1,364.14	1.3× median	Top 10%
14	1689891178	$2.6M	$1,195.91	1.1× median	Above Median
15	Boston Medical Center Corporation Boston, MA · General Acute Care Hospital	$2.3M	$1,404.39	1.3× median	Top 10%
16	The General Hospital Corporation Boston, MA · General Acute Care Hospital	$2.2M	$956.68	0.9× median	Below Median
17	1063406999	$1.9M	$1,140.99	1.1× median	Above Median
18	Tri-state Addiction Recovery Resources Huntington, WV · Community/Behavioral Health	$1.8M	$982.19	0.9× median	Below Median
19	1659751501	$1.7M	$863.15	0.8× median	Below Median
20	1841255296	$1.7M	$384.97	0.4× median	Below Median

Showing top 20 of 239 providers billing this code

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