J2794
Injection, risperidone, long-acting, per half milligram
Injection, risperidone, long-acting, per half milligram is the #2,924 most-billed Medicaid procedure code, with $3.0M in payments across 10K claims from 2018–2024. The national median cost per claim is $242.01. Costs vary widely — the 90th percentile is $716.53 per claim, 3.0× the median.
Total Paid
$3.0M
0.00% of all spending
Total Claims
10K
Providers
26
Avg Cost/Claim
$294
National Cost Distribution
How much do providers bill per claim for J2794? Based on 22 providers billing this code nationally.
Median
$242.01
Average
$355.86
Std Dev
$394.23
Max
$1,509.38
Percentile Distribution (Cost per Claim)
50% of providers bill between $40.62 and $569.58 per claim for this code.
90% bill between $2.61 and $716.53.
Top 1% bill above $1,434.48.
About This Procedure
HCPCS code J2794 (Injection, risperidone, long-acting, per half milligram) was billed by 26 providers across 10K claims, totaling $3.0M in Medicaid payments from 2018–2024. This code was used for 6K 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
$242.01
Providers Billing
22
National Spending
$3.0M
Avg/Median Ratio
1.47×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J2794
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1174693592 | $626K |
| 2 | 1053358945 | $440K |
| 3 | Bronxcare Health System Bronx, NY · General Acute Care Hospital | $299K |
| 4 | 1205853652 | $268K |
| 5 | 1578597993 | $228K |
| 6 | 1154433233 | $215K |
| 7 | 1700894730 | $147K |
| 8 | 1013924372 | $141K |
| 9 | Procare Pharmacy Direct, Llc. Monroeville, PA · Pharmacy, Community/Retail Pharmacy | $126K |
| 10 | New York City Health And Hospitals Corporation New York, NY · Internal Medicine | $124K |
| 11 | 1942217054 | $106K |
| 12 | New York City Health And Hospitals Corporation Brooklyn, NY · Internal Medicine | $103K |
| 13 | Broadlawns Medical Center Des Moines, IA · General Acute Care Hospital | $68K |
| 14 | 1205925567 | $65K |
| 15 | New York City Health And Hospitals Corporation Brooklyn, NY · Internal Medicine | $56K |
| 16 | 1831200310 | $8K |
| 17 | 1427168889 | $5K |
| 18 | University Of Rochester Rochester, NY · General Acute Care Hospital | $3K |
| 19 | 1528006103 | $2K |
| 20 | 1356397228 | $495 |
Showing top 20 of 26 providers billing this code