#6573 of 11K

J2358

HCPCS Procedure Code

HCPCS code J2358 is the #6,573 most-billed Medicaid procedure code, with $55K in payments across 4K claims from 2018–2024. The national median cost per claim is $11.56. Costs vary widely — the 90th percentile is $36.30 per claim, 3.1× the median.

Total Paid

$55K

0.00% of all spending

Total Claims

Providers

Avg Cost/Claim

$15

National Cost Distribution

How much do providers bill per claim for J2358? Based on 14 providers billing this code nationally.

Median

$11.56

Average

$16.13

Std Dev

$12.54

Max

$40.81

Percentile Distribution (Cost per Claim)

p10

$5.95

p25

$7.52

Median

$11.56

p75

$18.03

p90

$36.30

p95

$38.63

p99

$40.37

50% of providers bill between $7.52 and $18.03 per claim for this code.

90% bill between $5.95 and $36.30.

Top 1% bill above $40.37.

About This Procedure

HCPCS code J2358 was billed by 18 providers across 4K claims, totaling $55K in Medicaid payments from 2018–2024. This code was used for 3K 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

$11.56

Providers Billing

National Spending

$55K

Avg/Median Ratio

1.40×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J2358

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1417947490	$19K	$17.19	1.5× median	Above Median
2	The Lowell General Hospital Lowell, MA · Pharmacy, Institutional Pharmacy	$8K	$33.58	2.9× median	Above 75th
3	1154317964	$6K	$18.15	1.6× median	Above 75th
4	1548393127	$6K	$11.48	1.0× median	Below Median
5	1407813660	$5K	$37.46	3.2× median	Top 10%
6	1346230323	$3K	$9.10	0.8× median	Below Median
7	1114367497	$3K	$40.81	3.5× median	Top 1%
8	1710958228	$1K	$11.64	1.0× median	Above Median
9	1003281452	$991	$17.69	1.5× median	Above Median
10	1922033547	$846	$9.00	0.8× median	Below Median
11	1982697678	$506	$5.75	0.5× median	Below Median
12	Henry Ford Health System Detroit, MI · General Acute Care Hospital	$477	$7.02	0.6× median	Below Median
13	1316061997	$199	$6.43	0.6× median	Below Median
14	1316938327	$85	$0.56	0.0× median	Below Median
15	Carilion Medical Center Roanoke, VA · General Acute Care Hospital	$0	$0.00	0.0× median	Below Median
16	1346642899	$0	$0.00	0.0× median	Below Median
17	Yuma Regional Medical Center Yuma, AZ · General Acute Care Hospital	$0	$0.00	0.0× median	Below Median
18	Mainehealth Portland, ME · Emergency Medicine	$0	$0.00	0.0× median	Below Median

Showing top 18 of 18 providers billing this code

Related Procedures

J2350Ocrelizumab (Ocrevus) injection, 1 mg$391.8M J2357Injection, omalizumab, 5 mg$211.9M J2353Injection, octreotide, depot form, intramuscular, one milligram$9.8M J2356$1.3M J2360$845K

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