J8540
HCPCS Procedure Code
HCPCS code J8540 is the #3,011 most-billed Medicaid procedure code, with $2.8M in payments across 1.0M claims from 2018–2024. The national median cost per claim is $0.65. Costs vary widely — the 90th percentile is $4.55 per claim, 7.0× the median.
Total Paid
$2.8M
0.00% of all spending
Total Claims
1.0M
Providers
1,005
Avg Cost/Claim
$3
National Cost Distribution
How much do providers bill per claim for J8540? Based on 687 providers billing this code nationally.
Median
$0.65
Average
$3.57
Std Dev
$17.78
Max
$383.69
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.14 and $2.10 per claim for this code.
90% bill between $0.02 and $4.55.
Top 1% bill above $56.21.
About This Procedure
HCPCS code J8540 was billed by 1,005 providers across 1.0M claims, totaling $2.8M in Medicaid payments from 2018–2024. This code was used for 717K 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
$0.65
Providers Billing
687
National Spending
$2.8M
Avg/Median Ratio
5.49×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J8540
| # | Provider | Total Paid |
|---|---|---|
| 1 | University Of Utah Salt Lake City, UT · Clinic/Center, Dental | $770K |
| 2 | Rhode Island Hospital Providence, RI · General Acute Care Hospital | $194K |
| 3 | 1396790325 | $135K |
| 4 | 1417432840 | $114K |
| 5 | Carolinas Medical Center Charlotte, NC · General Acute Care Hospital | $79K |
| 6 | Antelope Valley Health Care District Lancaster, CA · General Acute Care Hospital | $66K |
| 7 | Inova Health Care Services Falls Church, VA · Clinic/Center, Rehabilitation, Substance Use Disorder | $63K |
| 8 | 1467560599 | $60K |
| 9 | 1225033020 | $48K |
| 10 | 1780653618 | $45K |
| 11 | Banner Desert Medical Center Mesa, AZ · General Acute Care Hospital | $41K |
| 12 | University Of Kentucky Lexington, KY · General Acute Care Hospital | $40K |
| 13 | 1952348047 | $36K |
| 14 | Childrens Hospital Of The Kings Daughters Inc Norfolk, VA · Social Worker, Clinical | $35K |
| 15 | 1003232976 | $35K |
| 16 | Virginia Commonwealth University Health System Authority Richmond, VA · General Acute Care Hospital | $34K |
| 17 | Uch-mhs Colorado Springs, CO · General Acute Care Hospital | $30K |
| 18 | 1255684460 | $29K |
| 19 | Rector & Visitors Of The University Of Virginia Charlottesville, VA · General Acute Care Hospital | $28K |
| 20 | 1497792550 | $28K |
Showing top 20 of 1,005 providers billing this code