J1020
HCPCS Procedure Code
HCPCS code J1020 is the #5,052 most-billed Medicaid procedure code, with $307K in payments across 88K claims from 2018–2024. The national median cost per claim is $2.63. Costs vary widely — the 90th percentile is $7.78 per claim, 3.0× the median.
Total Paid
$307K
0.00% of all spending
Total Claims
88K
Providers
287
Avg Cost/Claim
$3
National Cost Distribution
How much do providers bill per claim for J1020? Based on 240 providers billing this code nationally.
Median
$2.63
Average
$3.68
Std Dev
$4.18
Max
$33.77
Percentile Distribution (Cost per Claim)
50% of providers bill between $1.38 and $4.65 per claim for this code.
90% bill between $0.43 and $7.78.
Top 1% bill above $21.93.
About This Procedure
HCPCS code J1020 was billed by 287 providers across 88K claims, totaling $307K in Medicaid payments from 2018–2024. This code was used for 74K 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
$2.63
Providers Billing
240
National Spending
$307K
Avg/Median Ratio
1.40×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J1020
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1962696542 | $81K |
| 2 | 1316147242 | $19K |
| 3 | 1508285776 | $17K |
| 4 | 1437199882 | $12K |
| 5 | 1144757063 | $11K |
| 6 | Geisinger Clinic Danville, PA · Surgery | $11K |
| 7 | University Of Kentucky Lexington, KY · General Acute Care Hospital | $7K |
| 8 | 1891783916 | $6K |
| 9 | 1528546108 | $6K |
| 10 | 1841405859 | $5K |
| 11 | 1306873500 | $5K |
| 12 | 1063790608 | $5K |
| 13 | 1104963305 | $5K |
| 14 | 1235297847 | $5K |
| 15 | 1720395205 | $4K |
| 16 | 1487742722 | $4K |
| 17 | 1184976136 | $3K |
| 18 | 1205197894 | $3K |
| 19 | 1215054788 | $3K |
| 20 | 1356748685 | $3K |
Showing top 20 of 287 providers billing this code