J1642
HCPCS Procedure Code
HCPCS code J1642 is the #1,260 most-billed Medicaid procedure code, with $30.5M in payments across 2.7M claims from 2018–2024. The national median cost per claim is $1.11. Costs vary widely — the 90th percentile is $16.73 per claim, 15.1× the median.
Total Paid
$30.5M
0.00% of all spending
Total Claims
2.7M
Providers
1K
Avg Cost/Claim
$11
National Cost Distribution
How much do providers bill per claim for J1642? Based on 910 providers billing this code nationally.
Median
$1.11
Average
$11.17
Std Dev
$45.89
Max
$578.59
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.21 and $5.21 per claim for this code.
90% bill between $0.02 and $16.73.
Top 1% bill above $238.14.
About This Procedure
HCPCS code J1642 was billed by 1K providers across 2.7M claims, totaling $30.5M in Medicaid payments from 2018–2024. This code was used for 1.3M 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
$1.11
Providers Billing
910
National Spending
$30.5M
Avg/Median Ratio
10.06×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J1642
| # | Provider | Total Paid |
|---|---|---|
| 1 | Carolinas Medical Center Charlotte, NC · General Acute Care Hospital | $4.8M |
| 2 | Rhode Island Hospital Providence, RI · General Acute Care Hospital | $4.6M |
| 3 | 1942293691 | $2.6M |
| 4 | 1487699047 | $2.4M |
| 5 | 1104856095 | $1.6M |
| 6 | Central Florida Kidney Centers Inc Orlando, FL · Clinic/Center End-Stage Renal Disease (ESRD) Treatment | $955K |
| 7 | 1396087672 | $888K |
| 8 | 1831241033 | $746K |
| 9 | 1740648856 | $665K |
| 10 | 1316935851 | $469K |
| 11 | 1245277623 | $365K |
| 12 | 1457309247 | $346K |
| 13 | 1306871223 | $301K |
| 14 | Umass Memorial Medical Center, Inc. Worcester, MA · General Acute Care Hospital | $277K |
| 15 | Women & Infants Hospital Of Rhode Island Providence, RI · Clinic/Center, Ambulatory Family Planning Facility | $239K |
| 16 | 1982604021 | $196K |
| 17 | 1568474716 | $195K |
| 18 | 1073518007 | $179K |
| 19 | 1821147786 | $169K |
| 20 | Adventist Health System-sunbelt, Inc Orlando, FL · Ambulance, Land Transport | $161K |
Showing top 20 of 1K providers billing this code