#1500 of 11K

J0135

Injection, adalimumab, twenty milligrams

Injection, adalimumab, twenty milligrams is the #1,500 most-billed Medicaid procedure code, with $21.0M in payments across 28K claims from 2018–2024. The national median cost per claim is $2,044.06. Costs vary widely — the 90th percentile is $4,597.32 per claim, 2.2× the median.

Total Paid

$21.0M

0.00% of all spending

Total Claims

28K

Providers

Avg Cost/Claim

$739

National Cost Distribution

How much do providers bill per claim for J0135? Based on 25 providers billing this code nationally.

Median

$2,044.06

Average

$2,010.97

Std Dev

$1,703.40

Max

$5,137.16

Percentile Distribution (Cost per Claim)

p10

$5.59

p25

$501.63

Median

$2,044.06

p75

$2,816.32

p90

$4,597.32

p95

$5,066.31

p99

$5,132.41

50% of providers bill between $501.63 and $2,816.32 per claim for this code.

90% bill between $5.59 and $4,597.32.

Top 1% bill above $5,132.41.

About This Procedure

HCPCS code J0135 (Injection, adalimumab, twenty milligrams) was billed by 35 providers across 28K claims, totaling $21.0M in Medicaid payments from 2018–2024. This code was used for 23K 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

$2,044.06

Providers Billing

National Spending

$21.0M

Avg/Median Ratio

0.98×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J0135

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1114239332	$4.7M	$4,200.18	2.1× median	Above 75th
2	1972894772	$4.0M	$4,862.08	2.4× median	Top 10%
3	1992786495	$3.8M	$1,844.20	0.9× median	Below Median
4	1659550176	$1.2M	$5,117.37	2.5× median	Top 10%
5	1255644357	$1.1M	$2,044.06	1.0× median	Below Median
6	1689823486	$1.1M	$2,112.34	1.0× median	Above Median
7	1508315128	$1.1M	$2,576.34	1.3× median	Above Median
8	1295746709	$851K	$501.63	0.2× median	Below Median
9	1346241700	$457K	$5,137.16	2.5× median	Top 1%
10	1215124797	$408K	$661.65	0.3× median	Below Median
11	1972514503	$388K	$3,563.86	1.7× median	Above 75th
12	1013998921	$334K	$906.91	0.4× median	Below Median
13	1982776050	$300K	$3,490.06	1.7× median	Above 75th
14	1588804777	$298K	$2,462.39	1.2× median	Above Median
15	Optum Infusion Services 308 Llc Chandler, AZ · Pharmacy Home Infusion Therapy Pharmacy	$282K	$32.59	0.0× median	Below Median
16	1831241033	$217K	$1,525.88	0.7× median	Below Median
17	1891892535	$176K	$2,713.95	1.3× median	Above Median
18	1093130015	$94K	$2,767.89	1.4× median	Above Median
19	1922103142	$56K	$341.96	0.2× median	Below Median
20	1699096842	$53K	$581.51	0.3× median	Below Median

Showing top 20 of 35 providers billing this code

Related Procedures

J0129Injection, abatacept, ten milligrams intravenous$55.5M J0131$31.9M J0134$842K J0136$231K J0137$108K

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