J1094
HCPCS Procedure Code
HCPCS code J1094 is the #6,423 most-billed Medicaid procedure code, with $66K in payments across 28K claims from 2018–2024. The national median cost per claim is $0.24. Costs vary widely — the 90th percentile is $6.55 per claim, 27.3× the median.
Total Paid
$66K
0.00% of all spending
Total Claims
28K
Providers
116
Avg Cost/Claim
$2
National Cost Distribution
How much do providers bill per claim for J1094? Based on 66 providers billing this code nationally.
Median
$0.24
Average
$3.49
Std Dev
$11.47
Max
$75.12
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.05 and $1.09 per claim for this code.
90% bill between $0.01 and $6.55.
Top 1% bill above $56.52.
About This Procedure
HCPCS code J1094 was billed by 116 providers across 28K claims, totaling $66K in Medicaid payments from 2018–2024. This code was used for 23K 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
$0.24
Providers Billing
66
National Spending
$66K
Avg/Median Ratio
14.54×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J1094
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1437179710 | $26K |
| 2 | 1710984299 | $16K |
| 3 | 1790780047 | $16K |
| 4 | 1306832845 | $1K |
| 5 | 1043242142 | $993 |
| 6 | 1922273101 | $930 |
| 7 | 1568402576 | $480 |
| 8 | 1487699047 | $409 |
| 9 | Capital Health System, Inc. Pennington, NJ · General Acute Care Hospital | $331 |
| 10 | 1205871076 | $291 |
| 11 | 1104821461 | $277 |
| 12 | 1659431443 | $200 |
| 13 | 1659461143 | $165 |
| 14 | 1043218365 | $158 |
| 15 | 1013097120 | $143 |
| 16 | 1275583726 | $140 |
| 17 | 1215206016 | $128 |
| 18 | 1558740282 | $124 |
| 19 | 1194712083 | $117 |
| 20 | 1023301561 | $110 |
Showing top 20 of 116 providers billing this code