J0636
HCPCS Procedure Code
HCPCS code J0636 is the #5,403 most-billed Medicaid procedure code, with $208K in payments across 95K claims from 2018–2024. The national median cost per claim is $0.99. Costs vary widely — the 90th percentile is $10.20 per claim, 10.3× the median.
Total Paid
$208K
0.00% of all spending
Total Claims
95K
Providers
33
Avg Cost/Claim
$2
National Cost Distribution
How much do providers bill per claim for J0636? Based on 26 providers billing this code nationally.
Median
$0.99
Average
$4.64
Std Dev
$10.45
Max
$52.85
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.46 and $3.99 per claim for this code.
90% bill between $0.05 and $10.20.
Top 1% bill above $42.38.
About This Procedure
HCPCS code J0636 was billed by 33 providers across 95K claims, totaling $208K in Medicaid payments from 2018–2024. This code was used for 10K 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
$0.99
Providers Billing
26
National Spending
$208K
Avg/Median Ratio
4.69×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J0636
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1104844562 | $80K |
| 2 | 1730190331 | $26K |
| 3 | 1952476525 | $19K |
| 4 | 1255342861 | $17K |
| 5 | 1063421212 | $15K |
| 6 | 1588675110 | $10K |
| 7 | 1366533770 | $9K |
| 8 | 1043610819 | $8K |
| 9 | 1174793392 | $7K |
| 10 | 1841524360 | $4K |
| 11 | 1508831314 | $3K |
| 12 | 1578775045 | $2K |
| 13 | 1982065108 | $2K |
| 14 | 1710998380 | $1K |
| 15 | 1659770394 | $1K |
| 16 | 1912307596 | $507 |
| 17 | 1346209970 | $406 |
| 18 | 1316901457 | $354 |
| 19 | 1407807803 | $310 |
| 20 | 1255961397 | $269 |
Showing top 20 of 33 providers billing this code