J0640
HCPCS Procedure Code
HCPCS code J0640 is the #2,687 most-billed Medicaid procedure code, with $4.1M in payments across 193K claims from 2018–2024. The national median cost per claim is $24.08. Costs vary widely — the 90th percentile is $76.25 per claim, 3.2× the median.
Total Paid
$4.1M
0.00% of all spending
Total Claims
193K
Providers
209
Avg Cost/Claim
$22
National Cost Distribution
How much do providers bill per claim for J0640? Based on 167 providers billing this code nationally.
Median
$24.08
Average
$38.23
Std Dev
$78.29
Max
$888.03
Percentile Distribution (Cost per Claim)
50% of providers bill between $5.38 and $42.91 per claim for this code.
90% bill between $0.96 and $76.25.
Top 1% bill above $250.97.
About This Procedure
HCPCS code J0640 was billed by 209 providers across 193K claims, totaling $4.1M in Medicaid payments from 2018–2024. This code was used for 87K 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
$24.08
Providers Billing
167
National Spending
$4.1M
Avg/Median Ratio
1.59×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for J0640
| # | Provider | Total Paid |
|---|---|---|
| 1 | Alivia Specialty Llc Guaynabo, PR · Pharmacy Specialty Pharmacy | $318K |
| 2 | 1003989831 | $277K |
| 3 | Alameda Health System Oakland, CA · General Acute Care Hospital | $257K |
| 4 | City Of Hope National Medical Center Duarte, CA · General Acute Care Hospital | $216K |
| 5 | Long Island Jewish Medical Center New Hyde Park, NY · General Acute Care Hospital | $198K |
| 6 | Dana-farber Cancer Institute, Inc. Boston, MA · General Acute Care Hospital | $186K |
| 7 | Memorial Hospital For Cancer And Allied Diseases New York, NY · Pharmacy | $162K |
| 8 | The Cooper Health System Camden, NJ · General Acute Care Hospital | $151K |
| 9 | 1528018389 | $147K |
| 10 | Arrowhead Regional Medical Center Colton, CA · General Acute Care Hospital | $90K |
| 11 | Rhode Island Hospital Providence, RI · General Acute Care Hospital | $88K |
| 12 | 1295023547 | $86K |
| 13 | 1770728438 | $85K |
| 14 | Best Option Healthcare Puerto Rico Llc San Juan, PR · Pharmacy Home Infusion Therapy Pharmacy | $78K |
| 15 | Hmh Hospitals Corporation Hackensack, NJ · Ambulance | $74K |
| 16 | 1437230034 | $71K |
| 17 | 1740557503 | $66K |
| 18 | Seventh-day Adventists Loma Linda University Medical Center Loma Linda, CA · General Acute Care Hospital | $65K |
| 19 | 1013070572 | $62K |
| 20 | Dallas County Hospital District Dallas, TX · Clinic/Center, Ambulatory Surgical | $55K |
Showing top 20 of 209 providers billing this code