#5123 of 11K

J2780

HCPCS Procedure Code

HCPCS code J2780 is the #5,123 most-billed Medicaid procedure code, with $285K in payments across 35K claims from 2018–2024. The national median cost per claim is $4.00. Costs vary widely — the 90th percentile is $23.17 per claim, 5.8× the median.

Total Paid

$285K

0.00% of all spending

Total Claims

35K

Providers

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for J2780? Based on 59 providers billing this code nationally.

Median

$4.00

Average

$12.42

Std Dev

$31.25

Max

$223.51

Percentile Distribution (Cost per Claim)

p10

$0.91

p25

$1.98

Median

$4.00

p75

$8.72

p90

$23.17

p95

$32.33

p99

$146.69

50% of providers bill between $1.98 and $8.72 per claim for this code.

90% bill between $0.91 and $23.17.

Top 1% bill above $146.69.

About This Procedure

HCPCS code J2780 was billed by 70 providers across 35K claims, totaling $285K in Medicaid payments from 2018–2024. This code was used for 16K 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

$4.00

Providers Billing

National Spending

$285K

Avg/Median Ratio

3.10×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for J2780

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1760554059	$41K	$25.13	6.3× median	Top 10%
2	1740648856	$39K	$22.27	5.6× median	Above 75th
3	1528399193	$34K	$9.21	2.3× median	Above 75th
4	Scottish Rite Children's Medical Center Atlanta, GA · Pediatrics Pediatric Hematology-Oncology	$33K	$31.31	7.8× median	Top 10%
5	1568570109	$30K	$3.59	0.9× median	Below Median
6	1316925506	$27K	$223.51	55.9× median	Top 1%
7	1265628226	$14K	$5.22	1.3× median	Above Median
8	1851475677	$11K	$7.09	1.8× median	Above Median
9	1649344987	$8K	$41.59	10.4× median	Top 10%
10	1669462362	$8K	$6.97	1.7× median	Above Median
11	1003807355	$6K	$3.68	0.9× median	Below Median
12	1649688037	$3K	$91.07	22.8× median	Top 10%
13	1639172372	$3K	$9.60	2.4× median	Above 75th
14	Egleston Children's Hospital At Emory University Inc. Atlanta, GA · Pediatrics Pediatric Emergency Medicine	$3K	$22.68	5.7× median	Above 75th
15	1003989831	$3K	$18.32	4.6× median	Above 75th
16	1679900567	$2K	$2.34	0.6× median	Below Median
17	1164897963	$2K	$2.79	0.7× median	Below Median
18	1104813740	$1K	$18.70	4.7× median	Above 75th
19	1740396761	$1K	$1.00	0.2× median	Below Median
20	1609869916	$1K	$8.23	2.1× median	Above Median

Showing top 20 of 70 providers billing this code

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