J0401
HCPCS Procedure Code
HCPCS code J0401 is the #1,824 most-billed Medicaid procedure code, with $13.3M in payments across 23K claims from 2018–2024. The national median cost per claim is $714.38. Costs vary widely — the 90th percentile is $1,961.88 per claim, 2.7× the median.
Total Paid
$13.3M
0.00% of all spending
Total Claims
23K
Providers
71
Avg Cost/Claim
$587
National Cost Distribution
How much do providers bill per claim for J0401? Based on 63 providers billing this code nationally.
Median
$714.38
Average
$736.46
Std Dev
$716.37
Max
$2,219.78
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.07 and $1,253.54 per claim for this code.
90% bill between $0.01 and $1,961.88.
Top 1% bill above $2,186.27.
About This Procedure
HCPCS code J0401 was billed by 71 providers across 23K claims, totaling $13.3M in Medicaid payments from 2018–2024. This code was used for 19K 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
$714.38
Providers Billing
63
National Spending
$13.3M
Avg/Median Ratio
1.03×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J0401
| # | Provider | Total Paid |
|---|---|---|
| 1 | Bronxcare Health System Bronx, NY · General Acute Care Hospital | $1.9M |
| 2 | 1053358945 | $1.8M |
| 3 | Jefferson Center For Mental Health Wheat Ridge, CO · Clinic/Center Mental Health (Including Community Mental Health Center) | $1.2M |
| 4 | 1174693592 | $988K |
| 5 | 1053314021 | $970K |
| 6 | New York City Health And Hospitals Corporation Brooklyn, NY · Internal Medicine | $837K |
| 7 | Jersey City Medical Center Jersey City, NJ · General Acute Care Hospital | $642K |
| 8 | Procare Pharmacy Direct, Llc. Monroeville, PA · Pharmacy, Community/Retail Pharmacy | $621K |
| 9 | 1205853652 | $573K |
| 10 | 1417934175 | $377K |
| 11 | 1942217054 | $363K |
| 12 | 1154433233 | $353K |
| 13 | New York City Health And Hospitals Corporation Jamaica, NY · General Acute Care Hospital | $351K |
| 14 | 1336366822 | $344K |
| 15 | 1063428761 | $303K |
| 16 | New York City Health And Hospitals Corporation Brooklyn, NY · Internal Medicine | $301K |
| 17 | St Lukes Roosevelt Hospital Center New York, NY · Case Management | $220K |
| 18 | 1982610572 | $208K |
| 19 | 1811977796 | $149K |
| 20 | 1609983790 | $127K |
Showing top 20 of 71 providers billing this code