J2916
HCPCS Procedure Code
HCPCS code J2916 is the #2,119 most-billed Medicaid procedure code, with $8.8M in payments across 523K claims from 2018–2024. The national median cost per claim is $6.31. Costs vary widely — the 90th percentile is $54.79 per claim, 8.7× the median.
Total Paid
$8.8M
0.00% of all spending
Total Claims
523K
Providers
440
Avg Cost/Claim
$17
National Cost Distribution
How much do providers bill per claim for J2916? Based on 330 providers billing this code nationally.
Median
$6.31
Average
$22.33
Std Dev
$44.25
Max
$328.37
Percentile Distribution (Cost per Claim)
50% of providers bill between $2.22 and $19.42 per claim for this code.
90% bill between $0.49 and $54.79.
Top 1% bill above $212.17.
About This Procedure
HCPCS code J2916 was billed by 440 providers across 523K claims, totaling $8.8M in Medicaid payments from 2018–2024. This code was used for 172K 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
$6.31
Providers Billing
330
National Spending
$8.8M
Avg/Median Ratio
3.54×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J2916
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1316127921 | $1.4M |
| 2 | 1952333205 | $1.3M |
| 3 | 1346522679 | $763K |
| 4 | 1992779698 | $406K |
| 5 | Alivia Specialty Llc Guaynabo, PR · Pharmacy Specialty Pharmacy | $360K |
| 6 | 1669472882 | $342K |
| 7 | 1740267483 | $316K |
| 8 | Dialysis Clinic Inc Jacksonville, FL · Clinic/Center End-Stage Renal Disease (ESRD) Treatment | $280K |
| 9 | 1134308489 | $189K |
| 10 | 1558522151 | $132K |
| 11 | 1043785058 | $126K |
| 12 | 1467807180 | $120K |
| 13 | 1841201738 | $107K |
| 14 | 1700148632 | $104K |
| 15 | 1851324339 | $93K |
| 16 | 1003826090 | $86K |
| 17 | 1538405659 | $82K |
| 18 | 1316015258 | $74K |
| 19 | 1538395637 | $71K |
| 20 | 1326046467 | $67K |
Showing top 20 of 440 providers billing this code