J0641
HCPCS Procedure Code
HCPCS code J0641 is the #6,437 most-billed Medicaid procedure code, with $65K in payments across 225 claims from 2018–2024. The national median cost per claim is $88.88. Costs vary widely — the 90th percentile is $2,043.27 per claim, 23.0× the median.
Total Paid
$65K
0.00% of all spending
Total Claims
225
Providers
3
Avg Cost/Claim
$289
National Cost Distribution
How much do providers bill per claim for J0641? Based on 3 providers billing this code nationally.
Median
$88.88
Average
$878.32
Std Dev
$1,432.50
Max
$2,531.87
Percentile Distribution (Cost per Claim)
50% of providers bill between $51.54 and $1,310.37 per claim for this code.
90% bill between $29.15 and $2,043.27.
Top 1% bill above $2,483.01.
About This Procedure
HCPCS code J0641 was billed by 3 providers across 225 claims, totaling $65K in Medicaid payments from 2018–2024. This code was used for 101 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
$88.88
Providers Billing
3
National Spending
$65K
Avg/Median Ratio
9.88×
Highly skewed — outlier-driven
Provider Coverage
We have 3 providers billing this code in our dataset. Individual provider breakdowns are available for top-spending procedure codes.