#2301 of 11K

J7323

HCPCS Procedure Code

HCPCS code J7323 is the #2,301 most-billed Medicaid procedure code, with $7.0M in payments across 53K claims from 2018–2024. The national median cost per claim is $101.00. Costs vary widely — the 90th percentile is $335.77 per claim, 3.3× the median.

Total Paid

$7.0M

0.00% of all spending

Total Claims

53K

Providers

Avg Cost/Claim

$132

National Cost Distribution

How much do providers bill per claim for J7323? Based on 88 providers billing this code nationally.

Median

$101.00

Average

$144.50

Std Dev

$197.04

Max

$1,291.42

Percentile Distribution (Cost per Claim)

p10

$21.98

p25

$48.96

Median

$101.00

p75

$132.53

p90

$335.77

p95

$412.45

p99

$1,162.60

50% of providers bill between $48.96 and $132.53 per claim for this code.

90% bill between $21.98 and $335.77.

Top 1% bill above $1,162.60.

About This Procedure

HCPCS code J7323 was billed by 91 providers across 53K claims, totaling $7.0M in Medicaid payments from 2018–2024. This code was used for 25K 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

$101.00

Providers Billing

National Spending

$7.0M

Avg/Median Ratio

1.43×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J7323

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1083045140	$1.0M	$1,143.35	11.3× median	Top 10%
2	Unm Hospital Albuquerque, NM · General Acute Care Hospital	$671K	$198.65	2.0× median	Above 75th
3	1932400397	$495K	$433.29	4.3× median	Top 10%
4	1336187475	$467K	$134.08	1.3× median	Above 75th
5	Umass Memorial Medical Center, Inc. Worcester, MA · General Acute Care Hospital	$359K	$186.75	1.8× median	Above 75th
6	Arthritis & Rheumatology Associates Of South Jersey Pc Vineland, NJ · Internal Medicine Rheumatology	$347K	$574.67	5.7× median	Top 10%
7	Presbyterian Healthcare Services Albuquerque, NM · Surgery	$326K	$388.46	3.8× median	Top 10%
8	1013981554	$326K	$132.01	1.3× median	Above Median
9	Optum Medical Care Of New Jersey Pc Secaucus, NJ · Durable Medical Equipment & Medical Supplies	$247K	$107.15	1.1× median	Above Median
10	1295842615	$239K	$1,291.42	12.8× median	Top 1%
11	1871531426	$199K	$52.39	0.5× median	Below Median
12	1649217514	$189K	$102.34	1.0× median	Above Median
13	1629637475	$158K	$100.31	1.0× median	Below Median
14	1114962206	$157K	$252.59	2.5× median	Above 75th
15	1801843511	$109K	$371.05	3.7× median	Top 10%
16	1073827101	$103K	$120.98	1.2× median	Above Median
17	1922103142	$96K	$425.38	4.2× median	Top 10%
18	1437146743	$94K	$21.69	0.2× median	Below Median
19	1245340231	$88K	$26.90	0.3× median	Below Median
20	1619952595	$83K	$259.98	2.6× median	Above 75th

Showing top 20 of 91 providers billing this code

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