J0897
Injection, denosumab, one milligram
Injection, denosumab, one milligram is the #616 most-billed Medicaid procedure code, with $124.5M in payments across 176K claims from 2018–2024. The national median cost per claim is $493.25. Costs vary widely — the 90th percentile is $1,439.18 per claim, 2.9× the median.
Total Paid
$124.5M
0.01% of all spending
Total Claims
176K
Providers
389
Avg Cost/Claim
$709
National Cost Distribution
How much do providers bill per claim for J0897? Based on 363 providers billing this code nationally.
Median
$493.25
Average
$657.82
Std Dev
$567.71
Max
$3,456.21
Percentile Distribution (Cost per Claim)
50% of providers bill between $249.78 and $932.11 per claim for this code.
90% bill between $82.89 and $1,439.18.
Top 1% bill above $2,380.91.
About This Procedure
HCPCS code J0897 (Injection, denosumab, one milligram) was billed by 389 providers across 176K claims, totaling $124.5M in Medicaid payments from 2018–2024. This code was used for 151K 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
$493.25
Providers Billing
363
National Spending
$124.5M
Avg/Median Ratio
1.33×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J0897
| # | Provider | Total Paid |
|---|---|---|
| 1 | Alivia Specialty Llc Guaynabo, PR · Pharmacy Specialty Pharmacy | $8.3M |
| 2 | City Of Hope National Medical Center Duarte, CA · General Acute Care Hospital | $4.2M |
| 3 | Yale New Haven Hospital New Haven, CT · General Acute Care Hospital | $4.0M |
| 4 | Stanford Health Care Stanford, CA · General Acute Care Hospital | $3.8M |
| 5 | 1295023547 | $3.8M |
| 6 | Hmh Hospitals Corporation Hackensack, NJ · Ambulance | $3.8M |
| 7 | 1003989831 | $3.7M |
| 8 | Regents Of The University Of California San Diego, CA · General Acute Care Hospital | $3.1M |
| 9 | Long Island Jewish Medical Center New Hyde Park, NY · General Acute Care Hospital | $2.9M |
| 10 | University Of California Irvine Orange, CA · General Acute Care Hospital | $2.1M |
| 11 | Keck Medical Center Of Usc Los Angeles, CA · General Acute Care Hospital | $1.9M |
| 12 | Maimonides Medical Center Brooklyn, NY · General Acute Care Hospital | $1.9M |
| 13 | 1558575746 | $1.9M |
| 14 | State Of Mississippi - University Of Mississippi Medical Center Jackson, MS · General Acute Care Hospital | $1.7M |
| 15 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $1.7M |
| 16 | The Hospital Of Central Connecticut At New Britain General And Bradley New Britain, CT · General Acute Care Hospital | $1.6M |
| 17 | 1437230034 | $1.6M |
| 18 | Dana-farber Cancer Institute, Inc. Boston, MA · General Acute Care Hospital | $1.6M |
| 19 | 1598875460 | $1.5M |
| 20 | Beth Israel Medical Center Brooklyn, NY · Psychiatric Unit | $1.5M |
Showing top 20 of 389 providers billing this code