J0692
HCPCS Procedure Code
HCPCS code J0692 is the #4,655 most-billed Medicaid procedure code, with $465K in payments across 73K claims from 2018–2024. The national median cost per claim is $2.04. Costs vary widely — the 90th percentile is $25.14 per claim, 12.3× the median.
Total Paid
$465K
0.00% of all spending
Total Claims
73K
Providers
192
Avg Cost/Claim
$6
National Cost Distribution
How much do providers bill per claim for J0692? Based on 119 providers billing this code nationally.
Median
$2.04
Average
$12.00
Std Dev
$30.36
Max
$185.71
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.46 and $5.49 per claim for this code.
90% bill between $0.06 and $25.14.
Top 1% bill above $149.04.
About This Procedure
HCPCS code J0692 was billed by 192 providers across 73K claims, totaling $465K in Medicaid payments from 2018–2024. This code was used for 35K 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
$2.04
Providers Billing
119
National Spending
$465K
Avg/Median Ratio
5.88×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J0692
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1881915031 | $154K |
| 2 | 1518036458 | $53K |
| 3 | 1184606600 | $30K |
| 4 | Best Option Healthcare Puerto Rico Llc San Juan, PR · Pharmacy Home Infusion Therapy Pharmacy | $18K |
| 5 | 1902182637 | $17K |
| 6 | The General Hospital Corporation Boston, MA · General Acute Care Hospital | $15K |
| 7 | 1114099488 | $15K |
| 8 | Optum Infusion Services 308 Llc Chandler, AZ · Pharmacy Home Infusion Therapy Pharmacy | $12K |
| 9 | 1225033020 | $10K |
| 10 | 1457872632 | $10K |
| 11 | St. Mary's Medical Center Inc Huntington, WV · General Acute Care Hospital | $9K |
| 12 | Uofl Health-louisville Inc Louisville, KY · Psychiatric Hospital | $8K |
| 13 | 1912932336 | $8K |
| 14 | 1417947490 | $8K |
| 15 | Indiana University Health, Inc Indianapolis, IN · Durable Medical Equipment & Medical Supplies | $7K |
| 16 | Ashland Hospital Corporation Ashland, KY · Clinic/Center, Rural Health | $6K |
| 17 | Pikeville Medical Center Inc Pikeville, KY · General Acute Care Hospital | $6K |
| 18 | 1699756221 | $6K |
| 19 | Norton Hospitals, Inc Louisville, KY · General Acute Care Hospital | $5K |
| 20 | 1255336517 | $5K |
Showing top 20 of 192 providers billing this code