J0136
HCPCS Procedure Code
HCPCS code J0136 is the #5,310 most-billed Medicaid procedure code, with $231K in payments across 72K claims from 2018–2024. The national median cost per claim is $1.84. Costs vary widely — the 90th percentile is $12.54 per claim, 6.8× the median.
Total Paid
$231K
0.00% of all spending
Total Claims
72K
Providers
198
Avg Cost/Claim
$3
National Cost Distribution
How much do providers bill per claim for J0136? Based on 137 providers billing this code nationally.
Median
$1.84
Average
$5.21
Std Dev
$9.30
Max
$61.34
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.52 and $5.08 per claim for this code.
90% bill between $0.12 and $12.54.
Top 1% bill above $47.80.
About This Procedure
HCPCS code J0136 was billed by 198 providers across 72K claims, totaling $231K in Medicaid payments from 2018–2024. This code was used for 62K 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
$1.84
Providers Billing
137
National Spending
$231K
Avg/Median Ratio
2.83×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J0136
| # | Provider | Total Paid |
|---|---|---|
| 1 | Scottish Rite Children's Medical Center Atlanta, GA · Pediatrics Pediatric Hematology-Oncology | $30K |
| 2 | Variety Children's Hospital Weston, FL · General Acute Care Hospital Children | $20K |
| 3 | 1427123132 | $12K |
| 4 | Hmh Hospitals Corporation Hackensack, NJ · Ambulance | $11K |
| 5 | Adventist Health System-sunbelt Inc Orlando, FL · Clinical Medical Laboratory | $11K |
| 6 | 1427616002 | $10K |
| 7 | Ahs Hospital Corp. Morristown, NJ · General Acute Care Hospital | $8K |
| 8 | State Of Connecticut Farmington, CT · Counselor, Professional | $7K |
| 9 | 1760598700 | $7K |
| 10 | Children's Hospital Corporation Boston, MA · Clinic/Center | $7K |
| 11 | Pikeville Medical Center Inc Pikeville, KY · General Acute Care Hospital | $6K |
| 12 | 1013981554 | $6K |
| 13 | 1720537178 | $6K |
| 14 | Owensboro Health Inc Owensboro, KY · General Acute Care Hospital | $6K |
| 15 | 1811922347 | $5K |
| 16 | 1225033814 | $4K |
| 17 | 1407800436 | $4K |
| 18 | Hmh Hospitals Corporation Neptune, NJ · General Acute Care Hospital | $4K |
| 19 | 1710065933 | $4K |
| 20 | Childrens Hospital Of Philadelphia Philadelphia, PA · General Acute Care Hospital Children | $4K |
Showing top 20 of 198 providers billing this code