Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

#8204 of 11K

J2760

HCPCS Procedure Code

HCPCS code J2760 is the #8,204 most-billed Medicaid procedure code, with $5K in payments across 484 claims from 2018–2024. The national median cost per claim is $8.60. Costs vary widely — the 90th percentile is $89.12 per claim, 10.4× the median.

Total Paid

$5K

0.00% of all spending

Total Claims

484

Providers

4

Avg Cost/Claim

$10

National Cost Distribution

How much do providers bill per claim for J2760? Based on 3 providers billing this code nationally.

Median

$8.60

Average

$40.65

Std Dev

$59.45

Max

$109.25

Percentile Distribution (Cost per Claim)

p10
$5.01
p25
$6.36
Median
$8.60
p75
$58.92
p90
$89.12
p95
$99.18
p99
$107.23

50% of providers bill between $6.36 and $58.92 per claim for this code.

90% bill between $5.01 and $89.12.

Top 1% bill above $107.23.

About This Procedure

HCPCS code J2760 was billed by 4 providers across 484 claims, totaling $5K in Medicaid payments from 2018–2024. This code was used for 410 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

$8.60

Providers Billing

3

National Spending

$5K

Avg/Median Ratio

4.73×

Highly skewed — outlier-driven

Provider Coverage

We have 3 providers billing this code in our dataset. Individual provider breakdowns are available for top-spending procedure codes.

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