J0485
HCPCS Procedure Code
HCPCS code J0485 is the #1,514 most-billed Medicaid procedure code, with $20.6M in payments across 62K claims from 2018–2024. The national median cost per claim is $286.96. Costs vary widely — the 90th percentile is $713.54 per claim, 2.5× the median.
Total Paid
$20.6M
0.00% of all spending
Total Claims
62K
Providers
51
Avg Cost/Claim
$333
National Cost Distribution
How much do providers bill per claim for J0485? Based on 50 providers billing this code nationally.
Median
$286.96
Average
$363.53
Std Dev
$309.76
Max
$1,569.96
Percentile Distribution (Cost per Claim)
50% of providers bill between $144.83 and $446.65 per claim for this code.
90% bill between $66.67 and $713.54.
Top 1% bill above $1,357.35.
About This Procedure
HCPCS code J0485 was billed by 51 providers across 62K claims, totaling $20.6M in Medicaid payments from 2018–2024. This code was used for 30K 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
$286.96
Providers Billing
50
National Spending
$20.6M
Avg/Median Ratio
1.27×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J0485
| # | Provider | Total Paid |
|---|---|---|
| 1 | Yale New Haven Hospital New Haven, CT · General Acute Care Hospital | $2.7M |
| 2 | The New York And Presbyterian Hospital New York, NY · General Acute Care Hospital | $2.2M |
| 3 | Virginia Commonwealth University Health System Authority Richmond, VA · General Acute Care Hospital | $1.7M |
| 4 | Hmh Hospitals Corporation Hackensack, NJ · Ambulance | $1.5M |
| 5 | Mount Sinai Hospital New York, NY · Ambulance | $1.5M |
| 6 | 1639172372 | $1.3M |
| 7 | 1437230034 | $1.0M |
| 8 | Brigham & Womens Hospital Inc. Boston, MA · General Acute Care Hospital | $750K |
| 9 | The General Hospital Corporation Boston, MA · General Acute Care Hospital | $661K |
| 10 | Banner - University Medical Center Tucson Campus Llc Tucson, AZ · Clinic/Center, Multi-Specialty | $661K |
| 11 | Rector & Visitors Of The University Of Virginia Charlottesville, VA · General Acute Care Hospital | $645K |
| 12 | Inova Health Care Services Falls Church, VA · Clinic/Center, Rehabilitation, Substance Use Disorder | $598K |
| 13 | 1285902890 | $529K |
| 14 | Ohio State University Hospitals Columbus, OH · General Acute Care Hospital | $442K |
| 15 | 1396837951 | $425K |
| 16 | 1548393127 | $380K |
| 17 | Nyu Langone Hospitals New York, NY · Clinic/Center, Oncology | $374K |
| 18 | University Of California Irvine Orange, CA · General Acute Care Hospital | $320K |
| 19 | 1609846088 | $308K |
| 20 | Froedtert Memorial Lutheran Hospital, Inc. Milwaukee, WI · Clinic/Center, Radiology | $232K |
Showing top 20 of 51 providers billing this code