#3036 of 11K

J7320

HCPCS Procedure Code

HCPCS code J7320 is the #3,036 most-billed Medicaid procedure code, with $2.7M in payments across 37K claims from 2018–2024. The national median cost per claim is $39.61. Costs vary widely — the 90th percentile is $187.33 per claim, 4.7× the median.

Total Paid

$2.7M

0.00% of all spending

Total Claims

37K

Providers

Avg Cost/Claim

$73

National Cost Distribution

How much do providers bill per claim for J7320? Based on 47 providers billing this code nationally.

Median

$39.61

Average

$113.44

Std Dev

$296.68

Max

$2,029.97

Percentile Distribution (Cost per Claim)

p10

$5.78

p25

$23.02

Median

$39.61

p75

$95.43

p90

$187.33

p95

$311.45

p99

$1,247.56

50% of providers bill between $23.02 and $95.43 per claim for this code.

90% bill between $5.78 and $187.33.

Top 1% bill above $1,247.56.

About This Procedure

HCPCS code J7320 was billed by 55 providers across 37K claims, totaling $2.7M in Medicaid payments from 2018–2024. This code was used for 13K 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

$39.61

Providers Billing

National Spending

$2.7M

Avg/Median Ratio

2.86×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for J7320

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1285798033	$541K	$329.08	8.3× median	Top 10%
2	1306280177	$416K	$2,029.97	51.2× median	Top 1%
3	1760484042	$416K	$99.26	2.5× median	Above 75th
4	1922173442	$151K	$52.27	1.3× median	Above Median
5	1942591847	$151K	$85.16	2.1× median	Above Median
6	1477564607	$145K	$27.24	0.7× median	Below Median
7	1164522165	$117K	$176.64	4.5× median	Above 75th
8	1467614735	$88K	$37.20	0.9× median	Below Median
9	1962438564	$76K	$282.00	7.1× median	Top 10%
10	1225267388	$70K	$72.16	1.8× median	Above Median
11	1730359530	$62K	$34.54	0.9× median	Below Median
12	1700999117	$57K	$111.19	2.8× median	Above 75th
13	1366468274	$41K	$27.61	0.7× median	Below Median
14	1649203910	$37K	$39.61	1.0× median	Below Median
15	1952624595	$35K	$80.60	2.0× median	Above Median
16	1437555299	$33K	$32.82	0.8× median	Below Median
17	1902061070	$32K	$123.88	3.1× median	Above 75th
18	1780818609	$30K	$55.93	1.4× median	Above Median
19	1730486333	$23K	$22.57	0.6× median	Below Median
20	1235271958	$23K	$39.10	1.0× median	Below Median

Showing top 20 of 55 providers billing this code

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