J0696
HCPCS Procedure Code
HCPCS code J0696 is the #1,137 most-billed Medicaid procedure code, with $38.1M in payments across 8.4M claims from 2018–2024. The national median cost per claim is $1.34. Costs vary widely — the 90th percentile is $12.71 per claim, 9.5× the median.
Total Paid
$38.1M
0.00% of all spending
Total Claims
8.4M
Providers
6K
Avg Cost/Claim
$5
National Cost Distribution
How much do providers bill per claim for J0696? Based on 5K providers billing this code nationally.
Median
$1.34
Average
$5.56
Std Dev
$18.27
Max
$658.48
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.47 and $4.27 per claim for this code.
90% bill between $0.08 and $12.71.
Top 1% bill above $61.48.
About This Procedure
HCPCS code J0696 was billed by 6K providers across 8.4M claims, totaling $38.1M in Medicaid payments from 2018–2024. This code was used for 6.7M 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
$1.34
Providers Billing
5K
National Spending
$38.1M
Avg/Median Ratio
4.15×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J0696
| # | Provider | Total Paid |
|---|---|---|
| 1 | Yukon-kuskokwim Health Corporation Bethel, AK · General Acute Care Hospital Rural | $1.3M |
| 2 | University Of Utah Salt Lake City, UT · Clinic/Center, Dental | $1.1M |
| 3 | 1902182637 | $908K |
| 4 | 1831188275 | $560K |
| 5 | 1376513754 | $475K |
| 6 | 1548378029 | $465K |
| 7 | 1306873500 | $377K |
| 8 | 1902980865 | $351K |
| 9 | 1477500015 | $348K |
| 10 | 1396731105 | $340K |
| 11 | 1568474716 | $331K |
| 12 | 1831241033 | $329K |
| 13 | 1932562907 | $316K |
| 14 | 1144228446 | $273K |
| 15 | 1538141627 | $267K |
| 16 | 1518036458 | $262K |
| 17 | 1588959084 | $248K |
| 18 | 1275812935 | $229K |
| 19 | University Hospital Newark, NJ · General Acute Care Hospital | $228K |
| 20 | 1871556217 | $227K |
Showing top 20 of 6K providers billing this code