#1071 of 11K

J0490

HCPCS Procedure Code

HCPCS code J0490 is the #1,071 most-billed Medicaid procedure code, with $43.4M in payments across 29K claims from 2018–2024. The national median cost per claim is $1,422.77. Costs vary widely — the 90th percentile is $3,419.29 per claim, 2.4× the median.

Total Paid

$43.4M

0.00% of all spending

Total Claims

29K

Providers

Avg Cost/Claim

$1K

National Cost Distribution

How much do providers bill per claim for J0490? Based on 38 providers billing this code nationally.

Median

$1,422.77

Average

$1,739.97

Std Dev

$1,123.67

Max

$4,659.34

Percentile Distribution (Cost per Claim)

p10

$633.50

p25

$1,095.19

Median

$1,422.77

p75

$2,233.26

p90

$3,419.29

p95

$4,038.20

p99

$4,532.68

50% of providers bill between $1,095.19 and $2,233.26 per claim for this code.

90% bill between $633.50 and $3,419.29.

Top 1% bill above $4,532.68.

About This Procedure

HCPCS code J0490 was billed by 41 providers across 29K claims, totaling $43.4M in Medicaid payments from 2018–2024. This code was used for 16K 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

$1,422.77

Providers Billing

National Spending

$43.4M

Avg/Median Ratio

1.22×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J0490

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Yale New Haven Hospital New Haven, CT · General Acute Care Hospital	$5.7M	$1,309.61	0.9× median	Below Median
2	Arthritis & Rheumatology Associates Of South Jersey Pc Vineland, NJ · Internal Medicine Rheumatology	$5.4M	$1,093.11	0.8× median	Below Median
3	Procare Pharmacy Direct, Llc. Monroeville, PA · Pharmacy, Community/Retail Pharmacy	$4.8M	$3,613.99	2.5× median	Top 10%
4	1265462659	$4.4M	$1,256.43	0.9× median	Below Median
5	1528036019	$3.6M	$2,877.40	2.0× median	Above 75th
6	1548717580	$3.5M	$1,007.62	0.7× median	Below Median
7	University Of Rochester Rochester, NY · General Acute Care Hospital	$1.7M	$2,372.89	1.7× median	Above 75th
8	1427536325	$1.7M	$1,758.62	1.2× median	Above Median
9	Riverside University Health Systems - Medical Center Moreno Valley, CA · General Acute Care Hospital	$1.3M	$1,936.12	1.4× median	Above Median
10	Regents Of The University Of Michigan Ann Arbor, MI · Clinic/Center, End-Stage Renal Disease (ESRD) Treatment	$1.3M	$1,527.11	1.1× median	Above Median
11	1548742349	$1.2M	$2,000.69	1.4× median	Above Median
12	1891930673	$1.1M	$4,317.00	3.0× median	Top 10%
13	Childrens Hospital Of Los Angeles Los Angeles, CA · Case Manager/Care Coordinator	$1.1M	$1,745.64	1.2× median	Above Median
14	The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital	$1.0M	$1,608.38	1.1× median	Above Median
15	Alivia Specialty Llc Guaynabo, PR · Pharmacy Specialty Pharmacy	$794K	$3,335.84	2.3× median	Above 75th
16	1841246568	$689K	$1,340.06	0.9× median	Below Median
17	1366489254	$628K	$2,233.72	1.6× median	Above 75th
18	Phoenix Children's Hospital Phoenix, AZ · General Acute Care Hospital Children	$545K	$4,659.34	3.3× median	Top 1%
19	University Of California Irvine Orange, CA · General Acute Care Hospital	$541K	$1,128.61	0.8× median	Below Median
20	1366545311	$343K	$1,213.46	0.9× median	Below Median

Showing top 20 of 41 providers billing this code

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