J0491
HCPCS Procedure Code
HCPCS code J0491 is the #2,638 most-billed Medicaid procedure code, with $4.4M in payments across 1K claims from 2018–2024. The national median cost per claim is $3,574.59.
Total Paid
$4.4M
0.00% of all spending
Total Claims
1K
Providers
11
Avg Cost/Claim
$4K
National Cost Distribution
How much do providers bill per claim for J0491? Based on 11 providers billing this code nationally.
Median
$3,574.59
Average
$3,381.46
Std Dev
$998.35
Max
$4,708.21
Percentile Distribution (Cost per Claim)
50% of providers bill between $2,633.19 and $4,193.67 per claim for this code.
90% bill between $2,268.42 and $4,246.44.
Top 1% bill above $4,662.04.
About This Procedure
HCPCS code J0491 was billed by 11 providers across 1K claims, totaling $4.4M in Medicaid payments from 2018–2024. This code was used for 1K 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
$3,574.59
Providers Billing
11
National Spending
$4.4M
Avg/Median Ratio
0.95×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J0491
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1528036019 | $1.2M |
| 2 | 1821602194 | $912K |
| 3 | 1174822902 | $862K |
| 4 | 1891930673 | $858K |
| 5 | 1689288938 | $142K |
| 6 | 1104230176 | $141K |
| 7 | 1073932554 | $87K |
| 8 | Ohio State University Hospitals Columbus, OH · General Acute Care Hospital | $71K |
| 9 | Procare Pharmacy Direct, Llc. Monroeville, PA · Pharmacy, Community/Retail Pharmacy | $56K |
| 10 | The Cooper Health System Camden, NJ · General Acute Care Hospital | $43K |
| 11 | 1265462659 | $28K |
Showing top 11 of 11 providers billing this code