J1643
HCPCS Procedure Code
HCPCS code J1643 is the #8,225 most-billed Medicaid procedure code, with $5K in payments across 12K claims from 2018–2024. The national median cost per claim is $0.22. Costs vary widely — the 90th percentile is $4.00 per claim, 18.2× the median.
Total Paid
$5K
0.00% of all spending
Total Claims
12K
Providers
42
Avg Cost/Claim
$0
National Cost Distribution
How much do providers bill per claim for J1643? Based on 25 providers billing this code nationally.
Median
$0.22
Average
$1.17
Std Dev
$2.30
Max
$8.24
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.09 and $0.71 per claim for this code.
90% bill between $0.04 and $4.00.
Top 1% bill above $8.10.
About This Procedure
HCPCS code J1643 was billed by 42 providers across 12K claims, totaling $5K in Medicaid payments from 2018–2024. This code was used for 5K 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
$0.22
Providers Billing
25
National Spending
$5K
Avg/Median Ratio
5.32×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J1643
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1427055821 | $1K |
| 2 | Ashland Hospital Corporation Ashland, KY · Clinic/Center, Rural Health | $1K |
| 3 | Yale New Haven Hospital New Haven, CT · General Acute Care Hospital | $789 |
| 4 | Owensboro Health Inc Owensboro, KY · General Acute Care Hospital | $680 |
| 5 | Robert Wood Johnson University Hospital, Inc New Brunswick, NJ · General Acute Care Hospital | $169 |
| 6 | Hmh Hospitals Corporation Edison, NJ · General Acute Care Hospital | $125 |
| 7 | 1821186313 | $112 |
| 8 | Mary Imogene Bassett Hospital Cooperstown, NY · General Acute Care Hospital, Rural | $107 |
| 9 | Newark Beth Israel Medical Center Inc Newark, NJ · General Acute Care Hospital | $87 |
| 10 | 1619928017 | $68 |
| 11 | 1265437644 | $38 |
| 12 | 1003236878 | $38 |
| 13 | Jersey City Medical Center Jersey City, NJ · General Acute Care Hospital | $34 |
| 14 | University Of California Irvine Orange, CA · General Acute Care Hospital | $33 |
| 15 | Hmh Hospitals Corporation Hackensack, NJ · Ambulance | $32 |
| 16 | 1124099858 | $25 |
| 17 | Henry Ford Health St. John Hospital Chicago, IL · Clinic/Center, Ambulatory Surgical | $25 |
| 18 | The Cooper Health System Camden, NJ · General Acute Care Hospital | $18 |
| 19 | Charleston Area Medical Center Inc Charleston, WV · General Acute Care Hospital | $18 |
| 20 | 1821099474 | $12 |
Showing top 20 of 42 providers billing this code