J3490
Unclassified drugs
Unclassified drugs is the #274 most-billed Medicaid procedure code, with $510.2M in payments across 38.5M claims from 2018–2024. The national median cost per claim is $5.70. Costs vary widely — the 90th percentile is $69.69 per claim, 12.2× the median.
Total Paid
$510.2M
0.05% of all spending
Total Claims
38.5M
Providers
5K
Avg Cost/Claim
$13
National Cost Distribution
How much do providers bill per claim for J3490? Based on 4K providers billing this code nationally.
Median
$5.70
Average
$43.37
Std Dev
$590.21
Max
$35,419.05
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.84 and $26.63 per claim for this code.
90% bill between $0.10 and $69.69.
Top 1% bill above $428.49.
About This Procedure
HCPCS code J3490 (Unclassified drugs) was billed by 5K providers across 38.5M claims, totaling $510.2M in Medicaid payments from 2018–2024. This code was used for 17.9M 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
This procedure is featured in our investigation: Specialty Drug Costs
Read the full analysis for context on billing patterns associated with this code.
Billing Statistics
Median Cost/Claim
$5.70
Providers Billing
4K
National Spending
$510.2M
Avg/Median Ratio
7.61×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J3490
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1366823114 | $24.2M |
| 2 | Palomar Health Escondido, CA · General Acute Care Hospital | $18.7M |
| 3 | 1821017880 | $18.3M |
| 4 | Truman Medical Center, Incorporated Kansas City, MO · General Acute Care Hospital | $17.2M |
| 5 | 1629116645 | $16.4M |
| 6 | University Of Utah Salt Lake City, UT · Clinic/Center, Dental | $15.8M |
| 7 | 1740215219 | $13.3M |
| 8 | 1518039858 | $8.6M |
| 9 | Planned Parenthood/orange And San Bernardino Counties, Inc. Orange, CA · Clinic/Center, Ambulatory Family Planning Facility | $8.1M |
| 10 | 1114081056 | $7.7M |
| 11 | Carolinas Medical Center Charlotte, NC · General Acute Care Hospital | $7.1M |
| 12 | Nationwide Children's Hospital Columbus, OH · General Acute Care Hospital | $6.3M |
| 13 | Norton Hospitals, Inc Louisville, KY · General Acute Care Hospital | $5.4M |
| 14 | The Nemours Foundation Orlando, FL · General Acute Care Hospital Children | $5.3M |
| 15 | 1376513754 | $4.8M |
| 16 | Children's Hospital Corporation Boston, MA · Clinic/Center | $4.5M |
| 17 | 1104906569 | $4.5M |
| 18 | 1457382483 | $3.2M |
| 19 | Childrens Hospital Of Philadelphia Philadelphia, PA · General Acute Care Hospital Children | $3.2M |
| 20 | 1073518007 | $3.1M |
Showing top 20 of 5K providers billing this code