#2258 of 11K

J7999

HCPCS Procedure Code

HCPCS code J7999 is the #2,258 most-billed Medicaid procedure code, with $7.3M in payments across 466K claims from 2018–2024. The national median cost per claim is $6.94. Costs vary widely — the 90th percentile is $50.65 per claim, 7.3× the median.

Total Paid

$7.3M

0.00% of all spending

Total Claims

466K

Providers

567

Avg Cost/Claim

$16

National Cost Distribution

How much do providers bill per claim for J7999? Based on 373 providers billing this code nationally.

Median

$6.94

Average

$23.97

Std Dev

$107.95

Max

$1,965.45

Percentile Distribution (Cost per Claim)

p10

$0.05

p25

$0.84

Median

$6.94

p75

$22.87

p90

$50.65

p95

$62.06

p99

$217.25

50% of providers bill between $0.84 and $22.87 per claim for this code.

90% bill between $0.05 and $50.65.

Top 1% bill above $217.25.

About This Procedure

HCPCS code J7999 was billed by 567 providers across 466K claims, totaling $7.3M in Medicaid payments from 2018–2024. This code was used for 350K 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

$6.94

Providers Billing

373

National Spending

$7.3M

Avg/Median Ratio

3.45×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for J7999

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1205195732	$786K	$1,965.45	283.2× median	Top 1%
2	1700823051	$500K	$60.74	8.8× median	Top 10%
3	1619959731	$482K	$57.62	8.3× median	Top 10%
4	1750316014	$385K	$44.78	6.5× median	Above 75th
5	1336243393	$300K	$47.16	6.8× median	Above 75th
6	1720255110	$217K	$442.21	63.7× median	Top 1%
7	1699947796	$208K	$49.43	7.1× median	Above 75th
8	1801450291	$199K	$41.49	6.0× median	Above 75th
9	1104221035	$199K	$17.56	2.5× median	Above Median
10	Children's Hospital Medical Center Cincinnati, OH · Clinic/Center, Primary Care	$170K	$5.55	0.8× median	Below Median
11	1770528994	$131K	$15.31	2.2× median	Above Median
12	1033350756	$128K	$17.19	2.5× median	Above Median
13	1992746382	$125K	$73.14	10.5× median	Top 10%
14	1376574707	$123K	$56.54	8.1× median	Top 10%
15	1467611558	$121K	$84.69	12.2× median	Top 10%
16	1104813781	$119K	$19.11	2.8× median	Above Median
17	1114033404	$111K	$11.10	1.6× median	Above Median
18	1023063187	$111K	$50.90	7.3× median	Top 10%
19	Keck Medical Center Of Usc Los Angeles, CA · General Acute Care Hospital	$90K	$402.01	57.9× median	Top 1%
20	Brigham & Womens Hospital Inc. Boston, MA · General Acute Care Hospital	$89K	$11.51	1.7× median	Above Median

Showing top 20 of 567 providers billing this code

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