J9260
HCPCS Procedure Code
HCPCS code J9260 is the #5,482 most-billed Medicaid procedure code, with $189K in payments across 37K claims from 2018–2024. The national median cost per claim is $2.14. Costs vary widely — the 90th percentile is $9.74 per claim, 4.6× the median.
Total Paid
$189K
0.00% of all spending
Total Claims
37K
Providers
77
Avg Cost/Claim
$5
National Cost Distribution
How much do providers bill per claim for J9260? Based on 59 providers billing this code nationally.
Median
$2.14
Average
$7.08
Std Dev
$22.15
Max
$165.82
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.91 and $6.29 per claim for this code.
90% bill between $0.18 and $9.74.
Top 1% bill above $97.64.
About This Procedure
HCPCS code J9260 was billed by 77 providers across 37K claims, totaling $189K in Medicaid payments from 2018–2024. This code was used for 22K 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
$2.14
Providers Billing
59
National Spending
$189K
Avg/Median Ratio
3.31×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J9260
| # | Provider | Total Paid |
|---|---|---|
| 1 | Arkansas Childrens Hospital Little Rock, AR · Clinic/Center, Critical Access Hospital | $42K |
| 2 | Childrens Hospital Of Los Angeles Los Angeles, CA · Case Manager/Care Coordinator | $31K |
| 3 | Children's Health System Of Texas Dallas, TX · General Acute Care Hospital Children | $19K |
| 4 | 1811080526 | $19K |
| 5 | Scottish Rite Children's Medical Center Atlanta, GA · Pediatrics Pediatric Hematology-Oncology | $17K |
| 6 | Loma Linda University Children's Hospital Loma Linda, CA · General Acute Care Hospital Children | $10K |
| 7 | Egleston Children's Hospital At Emory University Inc. Atlanta, GA · Pediatrics Pediatric Emergency Medicine | $9K |
| 8 | 1700949336 | $7K |
| 9 | Long Island Jewish Medical Center New Hyde Park, NY · General Acute Care Hospital | $6K |
| 10 | 1467442749 | $4K |
| 11 | Dana-farber Cancer Institute, Inc. Boston, MA · General Acute Care Hospital | $3K |
| 12 | 1235234535 | $2K |
| 13 | 1447372487 | $2K |
| 14 | 1952440604 | $2K |
| 15 | Norton Hospitals Inc Louisville, KY · General Acute Care Hospital | $1K |
| 16 | Providence Health & Services Washington Anchorage, AK · General Acute Care Hospital | $1K |
| 17 | 1356505127 | $1K |
| 18 | 1710065933 | $1K |
| 19 | 1689744450 | $1K |
| 20 | 1174703946 | $1K |
Showing top 20 of 77 providers billing this code