J9263
HCPCS Procedure Code
HCPCS code J9263 is the #1,758 most-billed Medicaid procedure code, with $14.5M in payments across 113K claims from 2018–2024. The national median cost per claim is $28.73. Costs vary widely — the 90th percentile is $324.46 per claim, 11.3× the median.
Total Paid
$14.5M
0.00% of all spending
Total Claims
113K
Providers
145
Avg Cost/Claim
$128
National Cost Distribution
How much do providers bill per claim for J9263? Based on 122 providers billing this code nationally.
Median
$28.73
Average
$138.91
Std Dev
$366.97
Max
$3,399.17
Percentile Distribution (Cost per Claim)
50% of providers bill between $13.49 and $96.48 per claim for this code.
90% bill between $4.00 and $324.46.
Top 1% bill above $1,163.56.
About This Procedure
HCPCS code J9263 was billed by 145 providers across 113K claims, totaling $14.5M in Medicaid payments from 2018–2024. This code was used for 45K 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
$28.73
Providers Billing
122
National Spending
$14.5M
Avg/Median Ratio
4.84×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J9263
| # | Provider | Total Paid |
|---|---|---|
| 1 | Swedish Health Services Seattle, WA · General Acute Care Hospital | $2.4M |
| 2 | 1164493847 | $2.3M |
| 3 | 1740557503 | $1.7M |
| 4 | Multicare Health System Tacoma, WA · Community/Behavioral Health | $1.4M |
| 5 | Dana-farber Cancer Institute, Inc. Boston, MA · General Acute Care Hospital | $1.0M |
| 6 | The General Hospital Corporation Boston, MA · General Acute Care Hospital | $991K |
| 7 | Memorial Hospital For Cancer And Allied Diseases New York, NY · Pharmacy | $639K |
| 8 | Banner - University Medical Center Tucson Campus Llc Tucson, AZ · Clinic/Center, Multi-Specialty | $578K |
| 9 | 1003989831 | $431K |
| 10 | Rhode Island Hospital Providence, RI · General Acute Care Hospital | $220K |
| 11 | Alivia Specialty Llc Guaynabo, PR · Pharmacy Specialty Pharmacy | $182K |
| 12 | Robert Wood Johnson University Hospital, Inc New Brunswick, NJ · General Acute Care Hospital | $133K |
| 13 | Long Island Jewish Medical Center New Hyde Park, NY · General Acute Care Hospital | $121K |
| 14 | The Cooper Health System Camden, NJ · General Acute Care Hospital | $118K |
| 15 | Rector & Visitors Of The University Of Virginia Charlottesville, VA · General Acute Care Hospital | $111K |
| 16 | 1952446825 | $107K |
| 17 | Englewood Hospital And Medical Center Englewood, NJ · General Acute Care Hospital | $105K |
| 18 | 1699884858 | $91K |
| 19 | 1679660617 | $84K |
| 20 | Adventist Health System-sunbelt, Inc Orlando, FL · Ambulance, Land Transport | $79K |
Showing top 20 of 145 providers billing this code