#1547 of 11K

J7304

HCPCS Procedure Code

HCPCS code J7304 is the #1,547 most-billed Medicaid procedure code, with $19.6M in payments across 39K claims from 2018–2024. The national median cost per claim is $630.59.

Total Paid

$19.6M

0.00% of all spending

Total Claims

39K

Providers

109

Avg Cost/Claim

$509

National Cost Distribution

How much do providers bill per claim for J7304? Based on 108 providers billing this code nationally.

Median

$630.59

Average

$706.08

Std Dev

$499.85

Max

$2,542.41

Percentile Distribution (Cost per Claim)

p10

$197.42

p25

$333.93

Median

$630.59

p75

$874.38

p90

$1,227.29

p95

$1,378.62

p99

$2,442.65

50% of providers bill between $333.93 and $874.38 per claim for this code.

90% bill between $197.42 and $1,227.29.

Top 1% bill above $2,442.65.

About This Procedure

HCPCS code J7304 was billed by 109 providers across 39K claims, totaling $19.6M in Medicaid payments from 2018–2024. This code was used for 38K 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

$630.59

Providers Billing

108

National Spending

$19.6M

Avg/Median Ratio

1.12×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J7304

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Planned Parenthood/orange And San Bernardino Counties, Inc. Orange, CA · Clinic/Center, Ambulatory Family Planning Facility	$5.5M	$1,104.42	1.8× median	Above 75th
2	Planned Parenthood Of Wisconsin Milwaukee, WI · Clinic/Center Ambulatory Family Planning Facility	$2.3M	$193.81	0.3× median	Below Median
3	1629057146	$1.5M	$363.71	0.6× median	Below Median
4	1053364034	$867K	$873.42	1.4× median	Above Median
5	1336174325	$554K	$778.75	1.2× median	Above Median
6	1366496838	$450K	$977.76	1.6× median	Above 75th
7	1174579957	$443K	$976.11	1.5× median	Above 75th
8	1043263189	$440K	$731.17	1.2× median	Above Median
9	1215322797	$336K	$877.26	1.4× median	Above 75th
10	1477708469	$311K	$628.42	1.0× median	Below Median
11	1093969115	$275K	$330.21	0.5× median	Below Median
12	1184677163	$263K	$894.64	1.4× median	Above 75th
13	1962456558	$259K	$830.54	1.3× median	Above Median
14	1750316741	$242K	$853.42	1.4× median	Above Median
15	1487749495	$233K	$2,423.36	3.8× median	Top 10%
16	1316221617	$226K	$869.44	1.4× median	Above Median
17	1538152491	$222K	$376.91	0.6× median	Below Median
18	1225426588	$199K	$839.86	1.3× median	Above Median
19	1699113829	$182K	$1,012.20	1.6× median	Above 75th
20	1174923684	$178K	$772.78	1.2× median	Above Median

Showing top 20 of 109 providers billing this code

Related Procedures

J7307Etonogestrel implant system, including implant and supplies$192.3M J7298$77.8M J7300$20.8M J7297$8.1M J7303$4.9M

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