J0131
HCPCS Procedure Code
HCPCS code J0131 is the #1,238 most-billed Medicaid procedure code, with $31.9M in payments across 2.0M claims from 2018–2024. The national median cost per claim is $5.78. Costs vary widely — the 90th percentile is $42.28 per claim, 7.3× the median.
Total Paid
$31.9M
0.00% of all spending
Total Claims
2.0M
Providers
1K
Avg Cost/Claim
$16
National Cost Distribution
How much do providers bill per claim for J0131? Based on 981 providers billing this code nationally.
Median
$5.78
Average
$18.93
Std Dev
$45.58
Max
$690.51
Percentile Distribution (Cost per Claim)
50% of providers bill between $1.07 and $17.78 per claim for this code.
90% bill between $0.09 and $42.28.
Top 1% bill above $246.13.
About This Procedure
HCPCS code J0131 was billed by 1K providers across 2.0M claims, totaling $31.9M in Medicaid payments from 2018–2024. This code was used for 1.7M 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
$5.78
Providers Billing
981
National Spending
$31.9M
Avg/Median Ratio
3.28×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J0131
| # | Provider | Total Paid |
|---|---|---|
| 1 | Rhode Island Hospital Providence, RI · General Acute Care Hospital | $1.5M |
| 2 | Children's Hospital Corporation Boston, MA · Clinic/Center | $1.4M |
| 3 | Childrens Hospital Of Los Angeles Los Angeles, CA · Case Manager/Care Coordinator | $1.0M |
| 4 | University Of Utah Salt Lake City, UT · Clinic/Center, Dental | $982K |
| 5 | Charleston Area Medical Center Inc Charleston, WV · General Acute Care Hospital | $879K |
| 6 | West Virginia University Hospitals, Inc Morgantown, WV · Clinical Medical Laboratory | $858K |
| 7 | Pikeville Medical Center Inc Pikeville, KY · General Acute Care Hospital | $833K |
| 8 | Childrens Hospital Of Philadelphia Philadelphia, PA · General Acute Care Hospital Children | $603K |
| 9 | The Miriam Hospital Providence, RI · General Acute Care Hospital | $601K |
| 10 | 1013981554 | $594K |
| 11 | 1316938301 | $564K |
| 12 | 1295181477 | $477K |
| 13 | 1467459776 | $386K |
| 14 | Owensboro Health Inc Owensboro, KY · General Acute Care Hospital | $372K |
| 15 | 1407813660 | $366K |
| 16 | 1114984671 | $356K |
| 17 | 1073518007 | $351K |
| 18 | 1639523004 | $343K |
| 19 | 1043293608 | $339K |
| 20 | Englewood Hospital And Medical Center Englewood, NJ · General Acute Care Hospital | $316K |
Showing top 20 of 1K providers billing this code