#2140 of 11K

J2997

HCPCS Procedure Code

HCPCS code J2997 is the #2,140 most-billed Medicaid procedure code, with $8.5M in payments across 92K claims from 2018–2024. The national median cost per claim is $86.25. Costs vary widely — the 90th percentile is $246.71 per claim, 2.9× the median.

Total Paid

$8.5M

0.00% of all spending

Total Claims

92K

Providers

137

Avg Cost/Claim

$93

National Cost Distribution

How much do providers bill per claim for J2997? Based on 130 providers billing this code nationally.

Median

$86.25

Average

$132.53

Std Dev

$171.35

Max

$1,324.47

Percentile Distribution (Cost per Claim)

p10

$26.56

p25

$45.46

Median

$86.25

p75

$160.37

p90

$246.71

p95

$376.31

p99

$962.28

50% of providers bill between $45.46 and $160.37 per claim for this code.

90% bill between $26.56 and $246.71.

Top 1% bill above $962.28.

About This Procedure

HCPCS code J2997 was billed by 137 providers across 92K claims, totaling $8.5M in Medicaid payments from 2018–2024. This code was used for 47K 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

$86.25

Providers Billing

130

National Spending

$8.5M

Avg/Median Ratio

1.54×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for J2997

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1447539374	$1.4M	$71.23	0.8× median	Below Median
2	Arthur G James Cancer Hospital And Research Institute Columbus, OH · Special Hospital	$799K	$1,137.57	13.2× median	Top 1%
3	Nationwide Children's Hospital Columbus, OH · General Acute Care Hospital	$382K	$396.12	4.6× median	Top 10%
4	Yale New Haven Hospital New Haven, CT · General Acute Care Hospital	$361K	$108.24	1.3× median	Above Median
5	Norton Hospitals, Inc Louisville, KY · General Acute Care Hospital	$272K	$105.58	1.2× median	Above Median
6	Orlando Health Inc. Orlando, FL · General Acute Care Hospital	$248K	$153.90	1.8× median	Above Median
7	Childrens Hospital Of Los Angeles Los Angeles, CA · Case Manager/Care Coordinator	$244K	$85.61	1.0× median	Below Median
8	Phoenix Children's Hospital Phoenix, AZ · General Acute Care Hospital Children	$219K	$132.86	1.5× median	Above Median
9	Banner - University Medical Center Tucson Campus Llc Tucson, AZ · Clinic/Center, Multi-Specialty	$210K	$76.87	0.9× median	Below Median
10	Dana-farber Cancer Institute, Inc. Boston, MA · General Acute Care Hospital	$210K	$106.61	1.2× median	Above Median
11	1811041692	$204K	$61.81	0.7× median	Below Median
12	Virginia Commonwealth University Health System Authority Richmond, VA · General Acute Care Hospital	$195K	$110.24	1.3× median	Above Median
13	University Of Kentucky Lexington, KY · General Acute Care Hospital	$184K	$180.40	2.1× median	Above 75th
14	Norton Hospitals Inc Louisville, KY · General Acute Care Hospital	$180K	$44.09	0.5× median	Below Median
15	University Of Rochester Rochester, NY · General Acute Care Hospital	$179K	$184.86	2.1× median	Above 75th
16	1558575746	$157K	$34.91	0.4× median	Below Median
17	Children's Hospital Medical Center Cincinnati, OH · Clinic/Center, Primary Care	$149K	$253.76	2.9× median	Top 10%
18	Regents Of The University Of Michigan Ann Arbor, MI · Clinic/Center, End-Stage Renal Disease (ESRD) Treatment	$148K	$91.39	1.1× median	Above Median
19	University Hospitals Cleveland Medical Center Cleveland, OH · General Acute Care Hospital	$145K	$165.79	1.9× median	Above 75th
20	State Of Connecticut Farmington, CT · Counselor, Professional	$143K	$103.08	1.2× median	Above Median

Showing top 20 of 137 providers billing this code

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