#4436 of 11K

J2680

HCPCS Procedure Code

HCPCS code J2680 is the #4,436 most-billed Medicaid procedure code, with $592K in payments across 31K claims from 2018–2024. The national median cost per claim is $13.86.

Total Paid

$592K

0.00% of all spending

Total Claims

31K

Providers

Avg Cost/Claim

$19

National Cost Distribution

How much do providers bill per claim for J2680? Based on 28 providers billing this code nationally.

Median

$13.86

Average

$16.33

Std Dev

$15.86

Max

$85.42

Percentile Distribution (Cost per Claim)

p10

$3.36

p25

$6.98

Median

$13.86

p75

$19.68

p90

$27.19

p95

$29.12

p99

$70.26

50% of providers bill between $6.98 and $19.68 per claim for this code.

90% bill between $3.36 and $27.19.

Top 1% bill above $70.26.

About This Procedure

HCPCS code J2680 was billed by 31 providers across 31K claims, totaling $592K in Medicaid payments from 2018–2024. This code was used for 18K 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

$13.86

Providers Billing

National Spending

$592K

Avg/Median Ratio

1.18×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J2680

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	University Of Rochester Rochester, NY · General Acute Care Hospital	$168K	$85.42	6.2× median	Top 1%
2	1033300975	$69K	$29.29	2.1× median	Top 10%
3	1205925567	$62K	$14.63	1.1× median	Above Median
4	1245279595	$46K	$14.28	1.0× median	Above Median
5	1568476885	$42K	$18.87	1.4× median	Above Median
6	1609979640	$34K	$18.32	1.3× median	Above Median
7	1508814625	$28K	$19.09	1.4× median	Above Median
8	New York City Health And Hospitals Corporation Brooklyn, NY · Internal Medicine	$27K	$22.61	1.6× median	Above 75th
9	1952329153	$23K	$5.48	0.4× median	Below Median
10	1013476787	$22K	$12.70	0.9× median	Below Median
11	1811977796	$17K	$9.61	0.7× median	Below Median
12	Montefiore Medical Center Bronx, NY · General Acute Care Hospital	$16K	$26.50	1.9× median	Above 75th
13	1619995370	$8K	$14.16	1.0× median	Above Median
14	1831200310	$8K	$12.57	0.9× median	Below Median
15	1154433233	$4K	$25.49	1.8× median	Above 75th
16	1356397228	$4K	$3.60	0.3× median	Below Median
17	1982706883	$3K	$28.82	2.1× median	Top 10%
18	Richmond Medical Center Staten Island, NY · Psychiatric Unit	$2K	$21.45	1.5× median	Above 75th
19	1841374972	$2K	$11.45	0.8× median	Below Median
20	1427168889	$1K	$15.78	1.1× median	Above Median

Showing top 20 of 31 providers billing this code

Related Procedures

J2675$47K J2690$18K

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