J9255
HCPCS Procedure Code
HCPCS code J9255 is the #7,810 most-billed Medicaid procedure code, with $10K in payments across 1K claims from 2018–2024. The national median cost per claim is $9.95. Costs vary widely — the 90th percentile is $27.49 per claim, 2.8× the median.
Total Paid
$10K
0.00% of all spending
Total Claims
1K
Providers
6
Avg Cost/Claim
$7
National Cost Distribution
How much do providers bill per claim for J9255? Based on 5 providers billing this code nationally.
Median
$9.95
Average
$13.27
Std Dev
$14.08
Max
$37.20
Percentile Distribution (Cost per Claim)
50% of providers bill between $4.58 and $12.92 per claim for this code.
90% bill between $2.86 and $27.49.
Top 1% bill above $36.23.
About This Procedure
HCPCS code J9255 was billed by 6 providers across 1K claims, totaling $10K in Medicaid payments from 2018–2024. This code was used for 872 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
$9.95
Providers Billing
5
National Spending
$10K
Avg/Median Ratio
1.33×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J9255
| # | Provider | Total Paid |
|---|---|---|
| 1 | Scottish Rite Children's Medical Center Atlanta, GA · Pediatrics Pediatric Hematology-Oncology | $5K |
| 2 | 1689744450 | $3K |
| 3 | 1245217751 | $1K |
| 4 | Egleston Children's Hospital At Emory University Inc. Atlanta, GA · Pediatrics Pediatric Emergency Medicine | $705 |
| 5 | Rhode Island Hospital Providence, RI · General Acute Care Hospital | $328 |
| 6 | Regents Of The University Of Michigan Ann Arbor, MI · Clinic/Center, End-Stage Renal Disease (ESRD) Treatment | $0 |
Showing top 6 of 6 providers billing this code