J0697
HCPCS Procedure Code
HCPCS code J0697 is the #7,470 most-billed Medicaid procedure code, with $17K in payments across 18K claims from 2018–2024. The national median cost per claim is $0.91. Costs vary widely — the 90th percentile is $3.62 per claim, 4.0× the median.
Total Paid
$17K
0.00% of all spending
Total Claims
18K
Providers
40
Avg Cost/Claim
$1
National Cost Distribution
How much do providers bill per claim for J0697? Based on 21 providers billing this code nationally.
Median
$0.91
Average
$27.69
Std Dev
$116.22
Max
$534.32
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.12 and $2.49 per claim for this code.
90% bill between $0.03 and $3.62.
Top 1% bill above $432.65.
About This Procedure
HCPCS code J0697 was billed by 40 providers across 18K claims, totaling $17K in Medicaid payments from 2018–2024. This code was used for 13K 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
$0.91
Providers Billing
21
National Spending
$17K
Avg/Median Ratio
30.43×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J0697
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1619964806 | $6K |
| 2 | Johns Hopkins All Children's Hospital Inc St Petersburg, FL · General Acute Care Hospital Children | $3K |
| 3 | 1639101751 | $2K |
| 4 | 1295725448 | $2K |
| 5 | Riverside University Health Systems - Medical Center Moreno Valley, CA · General Acute Care Hospital | $2K |
| 6 | 1740221795 | $441 |
| 7 | 1205845567 | $319 |
| 8 | 1275627986 | $162 |
| 9 | University Of Wisconsin Hospitals And Clinics Authority Madison, WI · General Acute Care Hospital | $142 |
| 10 | 1568461572 | $141 |
| 11 | 1972742328 | $98 |
| 12 | Nyu Langone Hospitals Brooklyn, NY · General Acute Care Hospital | $50 |
| 13 | 1669584983 | $38 |
| 14 | 1982797684 | $36 |
| 15 | Bexar County Hospital District San Antonio, TX · Clinical Medical Laboratory | $33 |
| 16 | 1417958331 | $32 |
| 17 | Jersey City Medical Center Jersey City, NJ · General Acute Care Hospital | $6 |
| 18 | 1316015241 | $3 |
| 19 | University Of Kentucky Lexington, KY · General Acute Care Hospital | $1 |
| 20 | Froedtert Memorial Lutheran Hospital, Inc. Milwaukee, WI · Clinic/Center, Radiology | $1 |
Showing top 20 of 40 providers billing this code