#1869 of 11K

J9395

Injection, fulvestrant, twenty-five milligrams

Injection, fulvestrant, twenty-five milligrams is the #1,869 most-billed Medicaid procedure code, with $12.5M in payments across 26K claims from 2018–2024. The national median cost per claim is $367.29. Costs vary widely — the 90th percentile is $1,117.58 per claim, 3.0× the median.

Total Paid

$12.5M

0.00% of all spending

Total Claims

26K

Providers

Avg Cost/Claim

$485

National Cost Distribution

How much do providers bill per claim for J9395? Based on 45 providers billing this code nationally.

Median

$367.29

Average

$474.92

Std Dev

$432.58

Max

$1,658.18

Percentile Distribution (Cost per Claim)

p10

$58.59

p25

$151.63

Median

$367.29

p75

$663.73

p90

$1,117.58

p95

$1,441.35

p99

$1,610.33

50% of providers bill between $151.63 and $663.73 per claim for this code.

90% bill between $58.59 and $1,117.58.

Top 1% bill above $1,610.33.

About This Procedure

HCPCS code J9395 (Injection, fulvestrant, twenty-five milligrams) was billed by 48 providers across 26K claims, totaling $12.5M in Medicaid payments from 2018–2024. This code was used for 21K 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

$367.29

Providers Billing

National Spending

$12.5M

Avg/Median Ratio

1.29×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J9395

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1447539374	$2.3M	$1,191.98	3.2× median	Top 10%
2	1003989831	$2.0M	$1,658.18	4.5× median	Top 1%
3	Dana-farber Cancer Institute, Inc. Boston, MA · General Acute Care Hospital	$1.4M	$626.25	1.7× median	Above Median
4	1205819729	$713K	$1,498.47	4.1× median	Top 10%
5	Yale New Haven Hospital New Haven, CT · General Acute Care Hospital	$666K	$230.17	0.6× median	Below Median
6	Best Option Healthcare Puerto Rico Llc San Juan, PR · Pharmacy Home Infusion Therapy Pharmacy	$482K	$1,549.43	4.2× median	Top 10%
7	Alivia Specialty Llc Guaynabo, PR · Pharmacy Specialty Pharmacy	$442K	$433.82	1.2× median	Above Median
8	The General Hospital Corporation Boston, MA · General Acute Care Hospital	$401K	$467.48	1.3× median	Above Median
9	Regents Of The University Of California San Diego, CA · General Acute Care Hospital	$386K	$691.10	1.9× median	Above 75th
10	City Of Hope National Medical Center Duarte, CA · General Acute Care Hospital	$374K	$235.36	0.6× median	Below Median
11	Memorial Hospital For Cancer And Allied Diseases New York, NY · Pharmacy	$365K	$824.87	2.2× median	Above 75th
12	University Of California Irvine Orange, CA · General Acute Care Hospital	$340K	$362.94	1.0× median	Below Median
13	Hmh Hospitals Corporation Hackensack, NJ · Ambulance	$325K	$663.73	1.8× median	Above Median
14	Englewood Hospital And Medical Center Englewood, NJ · General Acute Care Hospital	$291K	$937.41	2.6× median	Above 75th
15	1164493847	$273K	$192.36	0.5× median	Below Median
16	1427536325	$197K	$649.63	1.8× median	Above Median
17	1528018389	$190K	$794.55	2.2× median	Above 75th
18	Swedish Health Services Seattle, WA · General Acute Care Hospital	$185K	$291.75	0.8× median	Below Median
19	1770690695	$166K	$417.54	1.1× median	Above Median
20	Arthur G James Cancer Hospital And Research Institute Columbus, OH · Special Hospital	$110K	$274.45	0.7× median	Below Median

Showing top 20 of 48 providers billing this code

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