#4736 of 11K

J9000

HCPCS Procedure Code

HCPCS code J9000 is the #4,736 most-billed Medicaid procedure code, with $425K in payments across 28K claims from 2018–2024. The national median cost per claim is $16.21. Costs vary widely — the 90th percentile is $36.53 per claim, 2.3× the median.

Total Paid

$425K

0.00% of all spending

Total Claims

28K

Providers

Avg Cost/Claim

$15

National Cost Distribution

How much do providers bill per claim for J9000? Based on 48 providers billing this code nationally.

Median

$16.21

Average

$19.01

Std Dev

$16.37

Max

$95.10

Percentile Distribution (Cost per Claim)

p10

$3.31

p25

$8.25

Median

$16.21

p75

$23.61

p90

$36.53

p95

$43.45

p99

$73.59

50% of providers bill between $8.25 and $23.61 per claim for this code.

90% bill between $3.31 and $36.53.

Top 1% bill above $73.59.

About This Procedure

HCPCS code J9000 was billed by 67 providers across 28K claims, totaling $425K in Medicaid payments from 2018–2024. This code was used for 15K 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

$16.21

Providers Billing

National Spending

$425K

Avg/Median Ratio

1.17×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J9000

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Memorial Hospital For Cancer And Allied Diseases New York, NY · Pharmacy	$82K	$37.93	2.3× median	Top 10%
2	Alivia Specialty Llc Guaynabo, PR · Pharmacy Specialty Pharmacy	$51K	$23.44	1.4× median	Above Median
3	1003989831	$40K	$41.90	2.6× median	Top 10%
4	Arthur G James Cancer Hospital And Research Institute Columbus, OH · Special Hospital	$26K	$44.28	2.7× median	Top 10%
5	Montefiore Medical Center Bronx, NY · General Acute Care Hospital	$24K	$21.84	1.3× median	Above Median
6	Dana-farber Cancer Institute, Inc. Boston, MA · General Acute Care Hospital	$24K	$8.05	0.5× median	Below Median
7	Regents Of The University Of California San Diego, CA · General Acute Care Hospital	$23K	$95.10	5.9× median	Top 1%
8	Long Island Jewish Medical Center New Hyde Park, NY · General Acute Care Hospital	$21K	$23.19	1.4× median	Above Median
9	City Of Hope National Medical Center Duarte, CA · General Acute Care Hospital	$13K	$20.45	1.3× median	Above Median
10	1528018389	$10K	$19.78	1.2× median	Above Median
11	Best Option Healthcare Puerto Rico Llc San Juan, PR · Pharmacy Home Infusion Therapy Pharmacy	$10K	$24.59	1.5× median	Above 75th
12	The New York And Presbyterian Hospital New York, NY · General Acute Care Hospital	$10K	$16.64	1.0× median	Above Median
13	Hmh Hospitals Corporation Hackensack, NJ · Ambulance	$8K	$20.94	1.3× median	Above Median
14	The New York And Presbyterian Hospital New York, NY · General Acute Care Hospital	$8K	$15.26	0.9× median	Below Median
15	University Of Kentucky Lexington, KY · General Acute Care Hospital	$8K	$21.73	1.3× median	Above Median
16	The Cooper Health System Camden, NJ · General Acute Care Hospital	$8K	$25.68	1.6× median	Above 75th
17	1437230034	$7K	$15.79	1.0× median	Below Median
18	The General Hospital Corporation Boston, MA · General Acute Care Hospital	$6K	$8.63	0.5× median	Below Median
19	Seventh-day Adventists Loma Linda University Medical Center Loma Linda, CA · General Acute Care Hospital	$6K	$34.58	2.1× median	Above 75th
20	The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital	$4K	$7.53	0.5× median	Below Median

Showing top 20 of 67 providers billing this code

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