J2543
HCPCS Procedure Code
HCPCS code J2543 is the #3,305 most-billed Medicaid procedure code, with $2.0M in payments across 410K claims from 2018–2024. The national median cost per claim is $2.87. Costs vary widely — the 90th percentile is $18.60 per claim, 6.5× the median.
Total Paid
$2.0M
0.00% of all spending
Total Claims
410K
Providers
677
Avg Cost/Claim
$5
National Cost Distribution
How much do providers bill per claim for J2543? Based on 496 providers billing this code nationally.
Median
$2.87
Average
$13.50
Std Dev
$93.83
Max
$1,994.84
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.63 and $7.37 per claim for this code.
90% bill between $0.07 and $18.60.
Top 1% bill above $140.75.
About This Procedure
HCPCS code J2543 was billed by 677 providers across 410K claims, totaling $2.0M in Medicaid payments from 2018–2024. This code was used for 200K 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
$2.87
Providers Billing
496
National Spending
$2.0M
Avg/Median Ratio
4.70×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J2543
| # | Provider | Total Paid |
|---|---|---|
| 1 | Pikeville Medical Center Inc Pikeville, KY · General Acute Care Hospital | $179K |
| 2 | 1750332565 | $165K |
| 3 | Umass Memorial Medical Center, Inc. Worcester, MA · General Acute Care Hospital | $140K |
| 4 | Uofl Health-louisville Inc Louisville, KY · Psychiatric Hospital | $115K |
| 5 | The General Hospital Corporation Boston, MA · General Acute Care Hospital | $64K |
| 6 | 1316917941 | $62K |
| 7 | The Miriam Hospital Providence, RI · General Acute Care Hospital | $40K |
| 8 | 1881915031 | $36K |
| 9 | 1043204316 | $32K |
| 10 | Virtua - West Jersey Health System Inc. Voorhees, NJ · General Acute Care Hospital | $31K |
| 11 | 1790732303 | $31K |
| 12 | 1003281452 | $27K |
| 13 | Dallas County Hospital District Dallas, TX · Clinic/Center, Ambulatory Surgical | $26K |
| 14 | 1114367497 | $24K |
| 15 | Charleston Area Medical Center Inc Charleston, WV · General Acute Care Hospital | $22K |
| 16 | Baystate Medical Center Inc Springfield, MA · General Acute Care Hospital | $20K |
| 17 | North Shore Medical Center, Inc. Salem, MA · General Acute Care Hospital | $20K |
| 18 | 1861439952 | $19K |
| 19 | The Lowell General Hospital Lowell, MA · Pharmacy, Institutional Pharmacy | $18K |
| 20 | 1568474716 | $18K |
Showing top 20 of 677 providers billing this code