J1438
HCPCS Procedure Code
HCPCS code J1438 is the #2,546 most-billed Medicaid procedure code, with $5.0M in payments across 11K claims from 2018–2024. The national median cost per claim is $1,184.84. Costs vary widely — the 90th percentile is $2,460.55 per claim, 2.1× the median.
Total Paid
$5.0M
0.00% of all spending
Total Claims
11K
Providers
18
Avg Cost/Claim
$456
National Cost Distribution
How much do providers bill per claim for J1438? Based on 12 providers billing this code nationally.
Median
$1,184.84
Average
$1,214.97
Std Dev
$961.35
Max
$2,800.70
Percentile Distribution (Cost per Claim)
50% of providers bill between $479.17 and $1,870.10 per claim for this code.
90% bill between $57.38 and $2,460.55.
Top 1% bill above $2,767.16.
About This Procedure
HCPCS code J1438 was billed by 18 providers across 11K claims, totaling $5.0M in Medicaid payments from 2018–2024. This code was used for 9K 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
$1,184.84
Providers Billing
12
National Spending
$5.0M
Avg/Median Ratio
1.03×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J1438
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1992786495 | $2.5M |
| 2 | 1114239332 | $1.1M |
| 3 | 1295746709 | $482K |
| 4 | 1346241700 | $208K |
| 5 | Optum Infusion Services 308 Llc Chandler, AZ · Pharmacy Home Infusion Therapy Pharmacy | $187K |
| 6 | 1972894772 | $185K |
| 7 | 1689823486 | $110K |
| 8 | 1013998921 | $76K |
| 9 | 1255644357 | $70K |
| 10 | 1588040786 | $39K |
| 11 | 1538300686 | $26K |
| 12 | 1215124797 | $5K |
| 13 | 1619478047 | $0 |
| 14 | 1013919240 | $0 |
| 15 | 1982901195 | $0 |
| 16 | 1962857896 | $0 |
| 17 | 1922103142 | $0 |
| 18 | 1346288255 | $0 |
Showing top 18 of 18 providers billing this code