#1987 of 11K

J0517

Injection, benralizumab, one milligram

Injection, benralizumab, one milligram is the #1,987 most-billed Medicaid procedure code, with $10.5M in payments across 3K claims from 2018–2024. The national median cost per claim is $2,255.19. Costs vary widely — the 90th percentile is $4,611.35 per claim, 2.0× the median.

Total Paid

$10.5M

0.00% of all spending

Total Claims

Providers

Avg Cost/Claim

$3K

National Cost Distribution

How much do providers bill per claim for J0517? Based on 14 providers billing this code nationally.

Median

$2,255.19

Average

$2,611.85

Std Dev

$1,588.30

Max

$4,779.05

Percentile Distribution (Cost per Claim)

p10

$699.80

p25

$1,541.16

Median

$2,255.19

p75

$4,239.52

p90

$4,611.35

p95

$4,717.15

p99

$4,766.67

50% of providers bill between $1,541.16 and $4,239.52 per claim for this code.

90% bill between $699.80 and $4,611.35.

Top 1% bill above $4,766.67.

About This Procedure

HCPCS code J0517 (Injection, benralizumab, one milligram) was billed by 16 providers across 3K claims, totaling $10.5M in Medicaid payments from 2018–2024. This code was used for 3K 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

$2,255.19

Providers Billing

National Spending

$10.5M

Avg/Median Ratio

1.16×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J0517

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Accredo Health Group Inc Memphis, TN · Pharmacy	$3.7M	$3,879.60	1.7× median	Above Median
2	1265462659	$2.2M	$2,238.68	1.0× median	Below Median
3	1083045140	$1.7M	$4,359.49	1.9× median	Above 75th
4	Procare Pharmacy Direct, Llc. Monroeville, PA · Pharmacy, Community/Retail Pharmacy	$1.2M	$4,683.83	2.1× median	Top 10%
5	1134100134	$458K	$4,442.25	2.0× median	Above 75th
6	1295842615	$416K	$4,779.05	2.1× median	Top 1%
7	1750399192	$319K	$1,340.06	0.6× median	Below Median
8	1710909478	$213K	$2,635.69	1.2× median	Above Median
9	New York City Health And Hospitals Corporation Bronx, NY · Internal Medicine	$150K	$555.25	0.2× median	Below Median
10	Yale New Haven Hospital New Haven, CT · General Acute Care Hospital	$61K	$2,271.69	1.0× median	Above Median
11	1871526459	$56K	$2,144.46	1.0× median	Below Median
12	State Of Connecticut Farmington, CT · Counselor, Professional	$42K	$2,198.69	1.0× median	Below Median
13	1407805971	$34K	$1,037.09	0.5× median	Below Median
14	1457384448	$0	$0.00	0.0× median	Below Median
15	1568459436	$0	$0.00	0.0× median	Below Median
16	1871962787	$0	$0.00	0.0× median	Below Median

Showing top 16 of 16 providers billing this code

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