#978 of 11K

J2785

HCPCS Procedure Code

HCPCS code J2785 is the #978 most-billed Medicaid procedure code, with $52.0M in payments across 776K claims from 2018–2024. The national median cost per claim is $61.83. Costs vary widely — the 90th percentile is $164.41 per claim, 2.7× the median.

Total Paid

$52.0M

0.00% of all spending

Total Claims

776K

Providers

Avg Cost/Claim

$67

National Cost Distribution

How much do providers bill per claim for J2785? Based on 1K providers billing this code nationally.

Median

$61.83

Average

$76.30

Std Dev

$72.19

Max

$675.31

Percentile Distribution (Cost per Claim)

p10

$1.68

p25

$18.16

Median

$61.83

p75

$117.64

p90

$164.41

p95

$205.90

p99

$313.54

50% of providers bill between $18.16 and $117.64 per claim for this code.

90% bill between $1.68 and $164.41.

Top 1% bill above $313.54.

About This Procedure

HCPCS code J2785 was billed by 2K providers across 776K claims, totaling $52.0M in Medicaid payments from 2018–2024. This code was used for 708K 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

$61.83

Providers Billing

National Spending

$52.0M

Avg/Median Ratio

1.23×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J2785

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Cardiovascular Institute Of San Diego Inc Chula Vista, CA · Internal Medicine, Advanced Heart Failure and Transplant Cardiology	$2.4M	$192.93	3.1× median	Top 10%
2	1831248236	$2.3M	$326.19	5.3× median	Top 1%
3	1982689113	$1.8M	$109.32	1.8× median	Above Median
4	1730137480	$950K	$106.10	1.7× median	Above Median
5	Englewood Hospital And Medical Center Englewood, NJ · General Acute Care Hospital	$917K	$112.19	1.8× median	Above Median
6	Pikeville Medical Center Inc Pikeville, KY · General Acute Care Hospital	$916K	$343.06	5.5× median	Top 1%
7	1164627295	$831K	$172.92	2.8× median	Top 10%
8	1811214489	$814K	$114.32	1.8× median	Above Median
9	Baptist Healthcare System Inc Corbin, KY · General Acute Care Hospital	$780K	$155.40	2.5× median	Above 75th
10	1962750224	$713K	$147.17	2.4× median	Above 75th
11	1427043777	$612K	$109.68	1.8× median	Above Median
12	1760441141	$578K	$110.82	1.8× median	Above Median
13	1689282147	$529K	$675.31	10.9× median	Top 1%
14	1902828841	$528K	$197.67	3.2× median	Top 10%
15	1184654923	$405K	$158.44	2.6× median	Above 75th
16	1437127297	$376K	$131.48	2.1× median	Above 75th
17	1770830606	$372K	$71.90	1.2× median	Above Median
18	1235134024	$362K	$126.72	2.0× median	Above 75th
19	1215042213	$358K	$165.38	2.7× median	Top 10%
20	1104856095	$347K	$292.61	4.7× median	Top 10%

Showing top 20 of 2K providers billing this code

Related Procedures

J2778$56.8M J2777$39.4M J2794Injection, risperidone, long-acting, per half milligram$3.0M J2795$2.2M J2790$657K

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