J0694
HCPCS Procedure Code
HCPCS code J0694 is the #4,999 most-billed Medicaid procedure code, with $324K in payments across 47K claims from 2018–2024. The national median cost per claim is $6.15. Costs vary widely — the 90th percentile is $25.84 per claim, 4.2× the median.
Total Paid
$324K
0.00% of all spending
Total Claims
47K
Providers
146
Avg Cost/Claim
$7
National Cost Distribution
How much do providers bill per claim for J0694? Based on 91 providers billing this code nationally.
Median
$6.15
Average
$11.19
Std Dev
$18.32
Max
$141.67
Percentile Distribution (Cost per Claim)
50% of providers bill between $1.65 and $12.99 per claim for this code.
90% bill between $0.35 and $25.84.
Top 1% bill above $80.62.
About This Procedure
HCPCS code J0694 was billed by 146 providers across 47K claims, totaling $324K in Medicaid payments from 2018–2024. This code was used for 34K 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
$6.15
Providers Billing
91
National Spending
$324K
Avg/Median Ratio
1.82×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for J0694
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1124078696 | $45K |
| 2 | Unm Hospital Albuquerque, NM · General Acute Care Hospital | $32K |
| 3 | Scottish Rite Children's Medical Center Atlanta, GA · Pediatrics Pediatric Hematology-Oncology | $29K |
| 4 | 1447457775 | $27K |
| 5 | 1811080526 | $23K |
| 6 | Baptist Healthcare System Inc Corbin, KY · General Acute Care Hospital | $18K |
| 7 | 1780681189 | $17K |
| 8 | Women & Infants Hospital Of Rhode Island Providence, RI · Clinic/Center, Ambulatory Family Planning Facility | $15K |
| 9 | 1992789721 | $13K |
| 10 | Charleston Area Medical Center Inc Charleston, WV · General Acute Care Hospital | $10K |
| 11 | 1609858950 | $7K |
| 12 | Ahs Hospital Corp. Morristown, NJ · General Acute Care Hospital | $5K |
| 13 | Loma Linda University Children's Hospital Loma Linda, CA · General Acute Care Hospital Children | $5K |
| 14 | County Of Ventura Ventura, CA · Clinic/Center, Emergency Care | $5K |
| 15 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $4K |
| 16 | 1891900635 | $4K |
| 17 | Norton Hospitals, Inc Louisville, KY · General Acute Care Hospital | $4K |
| 18 | 1881650737 | $4K |
| 19 | North Shore Medical Center, Inc. Salem, MA · General Acute Care Hospital | $4K |
| 20 | 1699704254 | $4K |
Showing top 20 of 146 providers billing this code