J0604
HCPCS Procedure Code
HCPCS code J0604 is the #1,360 most-billed Medicaid procedure code, with $25.7M in payments across 1.0M claims from 2018–2024. The national median cost per claim is $11.09. Costs vary widely — the 90th percentile is $183.25 per claim, 16.5× the median.
Total Paid
$25.7M
0.00% of all spending
Total Claims
1.0M
Providers
772
Avg Cost/Claim
$26
National Cost Distribution
How much do providers bill per claim for J0604? Based on 538 providers billing this code nationally.
Median
$11.09
Average
$56.40
Std Dev
$116.91
Max
$931.36
Percentile Distribution (Cost per Claim)
50% of providers bill between $2.76 and $43.44 per claim for this code.
90% bill between $0.60 and $183.25.
Top 1% bill above $643.88.
About This Procedure
HCPCS code J0604 was billed by 772 providers across 1.0M claims, totaling $25.7M in Medicaid payments from 2018–2024. This code was used for 166K 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
$11.09
Providers Billing
538
National Spending
$25.7M
Avg/Median Ratio
5.09×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J0604
| # | Provider | Total Paid |
|---|---|---|
| 1 | Dialysis Clinic Inc Jacksonville, FL · Clinic/Center End-Stage Renal Disease (ESRD) Treatment | $2.8M |
| 2 | 1003883125 | $957K |
| 3 | 1730190331 | $847K |
| 4 | 1881639342 | $696K |
| 5 | Rector & Visitors Of The University Of Virginia Charlottesville, VA · General Acute Care Hospital | $665K |
| 6 | 1801397526 | $657K |
| 7 | 1316059165 | $491K |
| 8 | 1194930693 | $483K |
| 9 | 1598746257 | $438K |
| 10 | 1912372293 | $436K |
| 11 | Renal Care Group Of The Southeast Inc. Pensacola, FL · Clinic/Center End-Stage Renal Disease (ESRD) Treatment | $405K |
| 12 | 1588776330 | $400K |
| 13 | 1669584413 | $387K |
| 14 | 1821186313 | $386K |
| 15 | 1336251198 | $383K |
| 16 | 1154399491 | $356K |
| 17 | 1457449282 | $349K |
| 18 | 1255579629 | $344K |
| 19 | 1548231608 | $331K |
| 20 | 1306958178 | $318K |
Showing top 20 of 772 providers billing this code