#2994 of 11K

J1631

HCPCS Procedure Code

HCPCS code J1631 is the #2,994 most-billed Medicaid procedure code, with $2.8M in payments across 118K claims from 2018–2024. The national median cost per claim is $15.34. Costs vary widely — the 90th percentile is $40.15 per claim, 2.6× the median.

Total Paid

$2.8M

0.00% of all spending

Total Claims

118K

Providers

106

Avg Cost/Claim

$24

National Cost Distribution

How much do providers bill per claim for J1631? Based on 93 providers billing this code nationally.

Median

$15.34

Average

$19.62

Std Dev

$17.87

Max

$87.07

Percentile Distribution (Cost per Claim)

p10

$1.20

p25

$5.18

Median

$15.34

p75

$31.03

p90

$40.15

p95

$47.19

p99

$83.49

50% of providers bill between $5.18 and $31.03 per claim for this code.

90% bill between $1.20 and $40.15.

Top 1% bill above $83.49.

About This Procedure

HCPCS code J1631 was billed by 106 providers across 118K claims, totaling $2.8M in Medicaid payments from 2018–2024. This code was used for 94K 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

$15.34

Providers Billing

National Spending

$2.8M

Avg/Median Ratio

1.28×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J1631

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	University Of Rochester Rochester, NY · General Acute Care Hospital	$312K	$83.18	5.4× median	Top 10%
2	1245279595	$275K	$29.28	1.9× median	Above Median
3	1205925567	$182K	$32.87	2.1× median	Above 75th
4	1508814625	$172K	$33.95	2.2× median	Above 75th
5	1053358945	$149K	$22.45	1.5× median	Above Median
6	New York City Health And Hospitals Corporation Brooklyn, NY · Internal Medicine	$144K	$33.26	2.2× median	Above 75th
7	1013476787	$123K	$29.10	1.9× median	Above Median
8	1609979640	$123K	$36.80	2.4× median	Above 75th
9	Unm Hospital Albuquerque, NM · General Acute Care Hospital	$76K	$64.25	4.2× median	Top 10%
10	1164457735	$75K	$15.93	1.0× median	Above Median
11	1568476885	$71K	$26.33	1.7× median	Above Median
12	Richmond Medical Center Staten Island, NY · Psychiatric Unit	$66K	$25.33	1.7× median	Above Median
13	1316904857	$65K	$27.79	1.8× median	Above Median
14	Montefiore Medical Center Bronx, NY · General Acute Care Hospital	$64K	$26.12	1.7× median	Above Median
15	Jersey City Medical Center Jersey City, NJ · General Acute Care Hospital	$58K	$21.31	1.4× median	Above Median
16	1154433233	$50K	$46.85	3.1× median	Top 10%
17	1508811324	$48K	$40.40	2.6× median	Top 10%
18	1952329153	$46K	$13.32	0.9× median	Below Median
19	1841374972	$45K	$33.29	2.2× median	Above 75th
20	1427168889	$45K	$17.56	1.1× median	Above Median

Showing top 20 of 106 providers billing this code

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