#1992 of 11K

J7605

HCPCS Procedure Code

HCPCS code J7605 is the #1,992 most-billed Medicaid procedure code, with $10.4M in payments across 193K claims from 2018–2024. The national median cost per claim is $47.35. Costs vary widely — the 90th percentile is $116.58 per claim, 2.5× the median.

Total Paid

$10.4M

0.00% of all spending

Total Claims

193K

Providers

Avg Cost/Claim

$54

National Cost Distribution

How much do providers bill per claim for J7605? Based on 37 providers billing this code nationally.

Median

$47.35

Average

$55.13

Std Dev

$38.30

Max

$127.50

Percentile Distribution (Cost per Claim)

p10

$4.01

p25

$37.51

Median

$47.35

p75

$78.49

p90

$116.58

p95

$121.73

p99

$126.42

50% of providers bill between $37.51 and $78.49 per claim for this code.

90% bill between $4.01 and $116.58.

Top 1% bill above $126.42.

About This Procedure

HCPCS code J7605 was billed by 39 providers across 193K claims, totaling $10.4M in Medicaid payments from 2018–2024. This code was used for 155K 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

$47.35

Providers Billing

National Spending

$10.4M

Avg/Median Ratio

1.16×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J7605

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1780748939	$4.7M	$52.00	1.1× median	Above Median
2	1275697435	$2.0M	$64.06	1.4× median	Above Median
3	1003970260	$1.8M	$51.04	1.1× median	Above Median
4	1114081270	$582K	$78.49	1.7× median	Above Median
5	1134698418	$565K	$42.09	0.9× median	Below Median
6	1114943610	$245K	$58.87	1.2× median	Above Median
7	1194725705	$228K	$56.42	1.2× median	Above Median
8	1912060740	$81K	$39.88	0.8× median	Below Median
9	1568465938	$57K	$54.62	1.2× median	Above Median
10	1669543591	$50K	$112.73	2.4× median	Above 75th
11	1043373350	$15K	$44.65	0.9× median	Below Median
12	1003977976	$10K	$47.35	1.0× median	Above Median
13	1265517460	$9K	$81.54	1.7× median	Above 75th
14	1851521488	$9K	$127.50	2.7× median	Top 1%
15	1578669529	$9K	$108.84	2.3× median	Above 75th
16	1417135757	$7K	$40.81	0.9× median	Below Median
17	1649352949	$5K	$41.12	0.9× median	Below Median
18	1437481520	$5K	$43.50	0.9× median	Below Median
19	1295817088	$4K	$58.55	1.2× median	Above Median
20	1649341579	$3K	$118.05	2.5× median	Top 10%

Showing top 20 of 39 providers billing this code

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