#4309 of 11K

J7295

HCPCS Procedure Code

HCPCS code J7295 is the #4,309 most-billed Medicaid procedure code, with $676K in payments across 6,595 claims from 2018–2024. The national median cost per claim is $148.11. Costs vary widely — the 90th percentile is $1,273.23 per claim, 8.6× the median.

Total Paid

$676K

0.00% of all spending

Total Claims

6,595

Providers

Avg Cost/Claim

$102

National Cost Distribution

How much do providers bill per claim for J7295? Based on 21 providers billing this code nationally.

Median

$148.11

Average

$384.32

Std Dev

$482.45

Max

$1,482.69

Percentile Distribution (Cost per Claim)

p10

$12.55

p25

$34.71

Median

$148.11

p75

$551.02

p90

$1,273.23

p95

$1,334.57

p99

$1,453.06

50% of providers bill between $34.71 and $551.02 per claim for this code.

90% bill between $12.55 and $1,273.23.

Top 1% bill above $1,453.06.

About This Procedure

HCPCS code J7295 was billed by 21 providers across 6,595 claims, totaling $676K in Medicaid payments from 2018–2024. This code was used for 6,367 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

$148.11

Providers Billing

National Spending

$676K

Avg/Median Ratio

2.59×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for J7295

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Planned Parenthood/orange And San Bernardino Counties, Inc. Orange, CA · Clinic/Center, Ambulatory Family Planning Facility	$197K	$148.11	1.0× median	Above Median
2	1588738389	$160K	$1,334.57	9.0× median	Top 10%
3	1629057146	$72K	$248.53	1.7× median	Above Median
4	1982777256	$67K	$1,482.69	10.0× median	Top 1%
5	1922151828	$59K	$694.05	4.7× median	Above 75th
6	1760535660	$24K	$951.57	6.4× median	Above 75th
7	1538152491	$21K	$34.71	0.2× median	Below Median
8	1316065170	$19K	$490.19	3.3× median	Above Median
9	1366496838	$15K	$1,273.23	8.6× median	Top 10%
10	1477708469	$11K	$279.16	1.9× median	Above Median
11	1174633143	$7K	$16.05	0.1× median	Below Median
12	1184641664	$7K	$551.02	3.7× median	Above 75th
13	1366525370	$6K	$33.07	0.2× median	Below Median
14	Planned Parenthood Of Wisconsin Milwaukee, WI · Clinic/Center Ambulatory Family Planning Facility	$3K	$0.93	0.0× median	Below Median
15	1255420436	$2K	$154.19	1.0× median	Above Median
16	1659671600	$2K	$138.18	0.9× median	Below Median
17	1093969115	$2K	$107.34	0.7× median	Below Median
18	1144260027	$1K	$66.97	0.5× median	Below Median
19	1053311860	$916	$12.55	0.1× median	Below Median
20	1649457474	$565	$43.49	0.3× median	Below Median

Showing top 20 of 21 providers billing this code

Related Procedures

J7298$77.8M J7300$20.8M J7304$19.6M J7297$8.1M J7303$4.9M

← All procedures Top providers →