J0613
HCPCS Procedure Code
HCPCS code J0613 is the #7,904 most-billed Medicaid procedure code, with $8K in payments across 5K claims from 2018–2024. The national median cost per claim is $1.26. Costs vary widely — the 90th percentile is $8.98 per claim, 7.1× the median.
Total Paid
$8K
0.00% of all spending
Total Claims
5K
Providers
30
Avg Cost/Claim
$2
National Cost Distribution
How much do providers bill per claim for J0613? Based on 18 providers billing this code nationally.
Median
$1.26
Average
$4.05
Std Dev
$8.07
Max
$33.76
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.48 and $2.91 per claim for this code.
90% bill between $0.23 and $8.98.
Top 1% bill above $30.17.
About This Procedure
HCPCS code J0613 was billed by 30 providers across 5K claims, totaling $8K in Medicaid payments from 2018–2024. This code was used for 3K 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
$1.26
Providers Billing
18
National Spending
$8K
Avg/Median Ratio
3.21×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J0613
| # | Provider | Total Paid |
|---|---|---|
| 1 | Unm Hospital Albuquerque, NM · General Acute Care Hospital | $4K |
| 2 | County Of Santa Clara San Jose, CA · Case Manager/Care Coordinator | $1K |
| 3 | Egleston Children's Hospital At Emory University Inc. Atlanta, GA · Pediatrics Pediatric Emergency Medicine | $1K |
| 4 | 1356925960 | $870 |
| 5 | New York Network Ipa Inc Brooklyn, NY · Exclusive Provider Organization | $630 |
| 6 | Hartford Hospital Hartford, CT · General Acute Care Hospital | $171 |
| 7 | 1669407185 | $130 |
| 8 | 1437119310 | $90 |
| 9 | 1427360700 | $74 |
| 10 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $72 |
| 11 | 1851326367 | $62 |
| 12 | Dayton Osteopathic Hospital Dayton, OH · General Acute Care Hospital | $48 |
| 13 | University Of Wisconsin Hospitals And Clinics Authority Madison, WI · General Acute Care Hospital | $43 |
| 14 | University Hospitals Cleveland Medical Center Cleveland, OH · General Acute Care Hospital | $33 |
| 15 | Miami Valley Hospital Dayton, OH · General Acute Care Hospital | $30 |
| 16 | Kaiser Foundation Hospitals Sacramento, CA · General Acute Care Hospital | $17 |
| 17 | Brigham & Womens Hospital Inc. Boston, MA · General Acute Care Hospital | $7 |
| 18 | Yuma Regional Medical Center Yuma, AZ · General Acute Care Hospital | $0 |
| 19 | Aurora Health Care Metro, Inc. Milwaukee, WI · Internal Medicine, Hematology & Oncology | $0 |
| 20 | Banner - University Medical Center Phoenix Phoenix, AZ · Clinic/Center, Sleep Disorder Diagnostic | $0 |
Showing top 20 of 30 providers billing this code