#4758 of 11K

J2805

HCPCS Procedure Code

HCPCS code J2805 is the #4,758 most-billed Medicaid procedure code, with $417K in payments across 6K claims from 2018–2024. The national median cost per claim is $76.93.

Total Paid

$417K

0.00% of all spending

Total Claims

Providers

Avg Cost/Claim

$70

National Cost Distribution

How much do providers bill per claim for J2805? Based on 42 providers billing this code nationally.

Median

$76.93

Average

$73.03

Std Dev

$34.34

Max

$137.49

Percentile Distribution (Cost per Claim)

p10

$27.87

p25

$47.61

Median

$76.93

p75

$102.28

p90

$114.40

p95

$117.46

p99

$133.34

50% of providers bill between $47.61 and $102.28 per claim for this code.

90% bill between $27.87 and $114.40.

Top 1% bill above $133.34.

About This Procedure

HCPCS code J2805 was billed by 49 providers across 6K claims, totaling $417K in Medicaid payments from 2018–2024. This code was used for 5K 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

$76.93

Providers Billing

National Spending

$417K

Avg/Median Ratio

0.95×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J2805

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1972004489	$197K	$77.45	1.0× median	Above Median
2	Baptist Healthcare System Inc Corbin, KY · General Acute Care Hospital	$31K	$109.30	1.4× median	Above 75th
3	1770581894	$18K	$81.09	1.1× median	Above Median
4	Norton Hospitals Inc Louisville, KY · General Acute Care Hospital	$16K	$56.49	0.7× median	Below Median
5	Owensboro Health Inc Owensboro, KY · General Acute Care Hospital	$14K	$110.77	1.4× median	Above 75th
6	Miami Valley Hospital Dayton, OH · General Acute Care Hospital	$14K	$115.14	1.5× median	Top 10%
7	1699704254	$13K	$71.14	0.9× median	Below Median
8	1184680480	$10K	$67.31	0.9× median	Below Median
9	Summa Health System Akron, OH · General Acute Care Hospital	$9K	$114.80	1.5× median	Top 10%
10	1568452290	$9K	$103.30	1.3× median	Above 75th
11	1366484594	$8K	$96.02	1.2× median	Above Median
12	Ashland Hospital Corporation Ashland, KY · Clinic/Center, Rural Health	$8K	$37.93	0.5× median	Below Median
13	1609869916	$7K	$80.83	1.1× median	Above Median
14	1629015698	$7K	$107.44	1.4× median	Above 75th
15	1427057967	$7K	$28.70	0.4× median	Below Median
16	1538244918	$5K	$86.67	1.1× median	Above Median
17	1710962204	$5K	$91.43	1.2× median	Above Median
18	Uofl Health-louisville Inc Louisville, KY · Psychiatric Hospital	$4K	$73.59	1.0× median	Below Median
19	1558313213	$4K	$45.25	0.6× median	Below Median
20	1053373480	$4K	$102.71	1.3× median	Above 75th

Showing top 20 of 49 providers billing this code

Related Procedures

J2796$4.1M J2795$2.2M J2800$152K J2806$4K J2798$0

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