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

#3033 of 11K

J3480

HCPCS Procedure Code

HCPCS code J3480 is the #3,033 most-billed Medicaid procedure code, with $2.7M in payments across 650K claims from 2018–2024. The national median cost per claim is $0.68. Costs vary widely — the 90th percentile is $10.74 per claim, 15.8× the median.

Total Paid

$2.7M

0.00% of all spending

Total Claims

650K

Providers

840

Avg Cost/Claim

$4

National Cost Distribution

How much do providers bill per claim for J3480? Based on 627 providers billing this code nationally.

Median

$0.68

Average

$4.60

Std Dev

$13.81

Max

$206.22

Percentile Distribution (Cost per Claim)

p10
$0.02
p25
$0.10
Median
$0.68
p75
$3.23
p90
$10.74
p95
$19.44
p99
$57.33

50% of providers bill between $0.10 and $3.23 per claim for this code.

90% bill between $0.02 and $10.74.

Top 1% bill above $57.33.

About This Procedure

HCPCS code J3480 was billed by 840 providers across 650K claims, totaling $2.7M in Medicaid payments from 2018–2024. This code was used for 397K 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

$0.68

Providers Billing

627

National Spending

$2.7M

Avg/Median Ratio

6.76×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for J3480

#ProviderTotal Paid
1The Nemours Foundation

Orlando, FL · General Acute Care Hospital Children

$738K
2Cook Children's Medical Center

Fort Worth, TX · General Acute Care Hospital Children

$253K
31144228446$126K
4Spartanburg Medical Center

Spartanburg, SC · Ambulance

$89K
51528399193$67K
61073518007$65K
7Upmc Children's Hospital Of Pittsburgh

Pittsburgh, PA · Clinic/Center

$57K
8Charleston Area Medical Center Inc

Charleston, WV · General Acute Care Hospital

$46K
91821147786$42K
101417952748$42K
11Seventh-day Adventists Loma Linda University Medical Center

Loma Linda, CA · General Acute Care Hospital

$42K
12St. Mary's Medical Center Inc

Huntington, WV · General Acute Care Hospital

$41K
131477671535$41K
14University Of Utah

Salt Lake City, UT · Clinic/Center, Dental

$39K
15University Of Kentucky

Lexington, KY · General Acute Care Hospital

$37K
16Norton Hospitals, Inc

Louisville, KY · General Acute Care Hospital

$37K
17University Medical Center, Inc

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

$36K
181700821808$36K
191134152549$32K
201619973542$29K

Showing top 20 of 840 providers billing this code