J1040
HCPCS Procedure Code
HCPCS code J1040 is the #2,292 most-billed Medicaid procedure code, with $7.0M in payments across 1.1M claims from 2018–2024. The national median cost per claim is $6.87.
Total Paid
$7.0M
0.00% of all spending
Total Claims
1.1M
Providers
2K
Avg Cost/Claim
$6
National Cost Distribution
How much do providers bill per claim for J1040? Based on 2K providers billing this code nationally.
Median
$6.87
Average
$7.78
Std Dev
$8.75
Max
$196.76
Percentile Distribution (Cost per Claim)
50% of providers bill between $3.32 and $10.03 per claim for this code.
90% bill between $0.72 and $13.20.
Top 1% bill above $39.15.
About This Procedure
HCPCS code J1040 was billed by 2K providers across 1.1M claims, totaling $7.0M in Medicaid payments from 2018–2024. This code was used for 933K 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
$6.87
Providers Billing
2K
National Spending
$7.0M
Avg/Median Ratio
1.13×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J1040
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1982735015 | $206K |
| 2 | Arthritis & Rheumatology Associates Of South Jersey Pc Vineland, NJ · Internal Medicine Rheumatology | $167K |
| 3 | 1194876136 | $160K |
| 4 | 1588710289 | $133K |
| 5 | 1275710964 | $114K |
| 6 | 1104875970 | $94K |
| 7 | University Of Utah Salt Lake City, UT · Clinic/Center, Dental | $90K |
| 8 | 1063439875 | $86K |
| 9 | 1861597072 | $85K |
| 10 | 1306280177 | $80K |
| 11 | 1629051529 | $76K |
| 12 | 1770624702 | $75K |
| 13 | 1285798033 | $73K |
| 14 | 1871531426 | $73K |
| 15 | 1578627782 | $69K |
| 16 | 1932562907 | $65K |
| 17 | 1699755397 | $58K |
| 18 | 1750343216 | $56K |
| 19 | 1902980865 | $56K |
| 20 | 1033356274 | $56K |
Showing top 20 of 2K providers billing this code