J9042
HCPCS Procedure Code
HCPCS code J9042 is the #2,664 most-billed Medicaid procedure code, with $4.3M in payments across 154 claims from 2018–2024. The national median cost per claim is $21,549.29.
Total Paid
$4.3M
0.00% of all spending
Total Claims
154
Providers
2
Avg Cost/Claim
$28K
National Cost Distribution
How much do providers bill per claim for J9042? Based on 2 providers billing this code nationally.
Median
$21,549.29
Average
$21,549.29
Std Dev
$22,856.41
Max
$37,711.21
Percentile Distribution (Cost per Claim)
50% of providers bill between $13,468.33 and $29,630.25 per claim for this code.
90% bill between $8,619.75 and $34,478.82.
Top 1% bill above $37,387.97.
About This Procedure
HCPCS code J9042 was billed by 2 providers across 154 claims, totaling $4.3M 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
$21,549.29
Providers Billing
2
National Spending
$4.3M
Avg/Median Ratio
1.00×
Normal distribution
Provider Coverage
We have 2 providers billing this code in our dataset. Individual provider breakdowns are available for top-spending procedure codes.