J9299
Nivolumab (Opdivo) injection, 1 mg
Nivolumab (Opdivo) injection, 1 mg is the #449 most-billed Medicaid procedure code, with $218.8M in payments across 59K claims from 2018–2024. The national median cost per claim is $3,562.28.
Total Paid
$218.8M
0.02% of all spending
Total Claims
59K
Providers
96
Avg Cost/Claim
$4K
National Cost Distribution
How much do providers bill per claim for J9299? Based on 91 providers billing this code nationally.
Median
$3,562.28
Average
$3,657.01
Std Dev
$2,429.37
Max
$12,407.71
Percentile Distribution (Cost per Claim)
50% of providers bill between $1,813.39 and $4,828.71 per claim for this code.
90% bill between $729.49 and $6,544.43.
Top 1% bill above $10,840.37.
About This Procedure
HCPCS code J9299 (Nivolumab (Opdivo) injection, 1 mg) was billed by 96 providers across 59K claims, totaling $218.8M in Medicaid payments from 2018–2024. This code was used for 32K 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
$3,562.28
Providers Billing
91
National Spending
$218.8M
Avg/Median Ratio
1.03×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J9299
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1003989831 | $15.2M |
| 2 | Alivia Specialty Llc Guaynabo, PR · Pharmacy Specialty Pharmacy | $14.6M |
| 3 | 1528018389 | $12.4M |
| 4 | Yale New Haven Hospital New Haven, CT · General Acute Care Hospital | $11.5M |
| 5 | University Of Kentucky Lexington, KY · General Acute Care Hospital | $11.4M |
| 6 | Dana-farber Cancer Institute, Inc. Boston, MA · General Acute Care Hospital | $10.9M |
| 7 | Regents Of The University Of California San Diego, CA · General Acute Care Hospital | $10.4M |
| 8 | Arthur G James Cancer Hospital And Research Institute Columbus, OH · Special Hospital | $9.1M |
| 9 | 1447539374 | $8.1M |
| 10 | City Of Hope National Medical Center Duarte, CA · General Acute Care Hospital | $8.1M |
| 11 | University Of California Irvine Orange, CA · General Acute Care Hospital | $7.2M |
| 12 | 1497737183 | $6.4M |
| 13 | Mount Sinai Hospital New York, NY · Ambulance | $6.0M |
| 14 | Stanford Health Care Stanford, CA · General Acute Care Hospital | $5.2M |
| 15 | Keck Medical Center Of Usc Los Angeles, CA · General Acute Care Hospital | $5.1M |
| 16 | Hmh Hospitals Corporation Hackensack, NJ · Ambulance | $5.0M |
| 17 | Long Island Jewish Medical Center New Hyde Park, NY · General Acute Care Hospital | $4.8M |
| 18 | Memorial Hospital For Cancer And Allied Diseases New York, NY · Pharmacy | $4.8M |
| 19 | 1164493847 | $4.4M |
| 20 | University Medical Center, Inc Louisville, KY · Student in an Organized Health Care Education/Training Program | $4.2M |
Showing top 20 of 96 providers billing this code