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

#3217 of 11K

J2795

HCPCS Procedure Code

HCPCS code J2795 is the #3,217 most-billed Medicaid procedure code, with $2.2M in payments across 549K claims from 2018–2024. The national median cost per claim is $0.96. Costs vary widely — the 90th percentile is $15.42 per claim, 16.1× the median.

Total Paid

$2.2M

0.00% of all spending

Total Claims

549K

Providers

800

Avg Cost/Claim

$4

National Cost Distribution

How much do providers bill per claim for J2795? Based on 493 providers billing this code nationally.

Median

$0.96

Average

$6.97

Std Dev

$22.69

Max

$300.00

Percentile Distribution (Cost per Claim)

p10
$0.02
p25
$0.10
Median
$0.96
p75
$4.88
p90
$15.42
p95
$29.52
p99
$89.23

50% of providers bill between $0.10 and $4.88 per claim for this code.

90% bill between $0.02 and $15.42.

Top 1% bill above $89.23.

About This Procedure

HCPCS code J2795 was billed by 800 providers across 549K claims, totaling $2.2M in Medicaid payments from 2018–2024. This code was used for 433K 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

$0.96

Providers Billing

493

National Spending

$2.2M

Avg/Median Ratio

7.26×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for J2795

#ProviderTotal Paid
1University Of Utah

Salt Lake City, UT · Clinic/Center, Dental

$153K
2West Virginia University Hospitals, Inc

Morgantown, WV · Clinical Medical Laboratory

$138K
3Owensboro Health Inc

Owensboro, KY · General Acute Care Hospital

$120K
4Uofl Health-louisville Inc

Louisville, KY · Psychiatric Hospital

$101K
51235139312$98K
6Pikeville Medical Center Inc

Pikeville, KY · General Acute Care Hospital

$82K
7University Of Kentucky

Lexington, KY · General Acute Care Hospital

$79K
8Norton Hospitals, Inc

Louisville, KY · General Acute Care Hospital

$70K
9Virginia Commonwealth University Health System Authority

Richmond, VA · General Acute Care Hospital

$68K
101457319485$64K
11Scottish Rite Children's Medical Center

Atlanta, GA · Pediatrics Pediatric Hematology-Oncology

$54K
12Norton Hospitals Inc

Louisville, KY · General Acute Care Hospital

$50K
131447457775$50K
141073518007$47K
151538244918$44K
161184606600$43K
17Unm Hospital

Albuquerque, NM · General Acute Care Hospital

$42K
18University Medical Center, Inc

Louisville, KY · Student in an Organized Health Care Education/Training Program

$42K
191285253252$39K
201992701429$36K

Showing top 20 of 800 providers billing this code