J0515
HCPCS Procedure Code
HCPCS code J0515 is the #6,950 most-billed Medicaid procedure code, with $35K in payments across 2K claims from 2018–2024. The national median cost per claim is $20.78. Costs vary widely — the 90th percentile is $47.04 per claim, 2.3× the median.
Total Paid
$35K
0.00% of all spending
Total Claims
2K
Providers
8
Avg Cost/Claim
$20
National Cost Distribution
How much do providers bill per claim for J0515? Based on 7 providers billing this code nationally.
Median
$20.78
Average
$28.53
Std Dev
$17.22
Max
$63.74
Percentile Distribution (Cost per Claim)
50% of providers bill between $18.31 and $32.32 per claim for this code.
90% bill between $15.82 and $47.04.
Top 1% bill above $62.07.
About This Procedure
HCPCS code J0515 was billed by 8 providers across 2K claims, totaling $35K in Medicaid payments from 2018–2024. This code was used for 2K 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
$20.78
Providers Billing
7
National Spending
$35K
Avg/Median Ratio
1.37×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J0515
| # | Provider | Total Paid |
|---|---|---|
| 1 | Swedish Health Services Seattle, WA · General Acute Care Hospital | $13K |
| 2 | New York City Health And Hospitals Corporation Brooklyn, NY · Internal Medicine | $11K |
| 3 | 1013924372 | $8K |
| 4 | 1346293156 | $1K |
| 5 | 1073510277 | $956 |
| 6 | 1417975061 | $920 |
| 7 | 1811941883 | $342 |
| 8 | Brockton Hospital, Inc. Brockton, MA · General Acute Care Hospital | $0 |
Showing top 8 of 8 providers billing this code