J1738
HCPCS Procedure Code
HCPCS code J1738 is the #8,551 most-billed Medicaid procedure code, with $2K in payments across 304 claims from 2018–2024. The national median cost per claim is $5.98.
Total Paid
$2K
0.00% of all spending
Total Claims
304
Providers
3
Avg Cost/Claim
$7
National Cost Distribution
How much do providers bill per claim for J1738? Based on 2 providers billing this code nationally.
Median
$5.98
Average
$5.98
Std Dev
$4.41
Max
$9.09
Percentile Distribution (Cost per Claim)
50% of providers bill between $4.42 and $7.53 per claim for this code.
90% bill between $3.48 and $8.47.
Top 1% bill above $9.03.
About This Procedure
HCPCS code J1738 was billed by 3 providers across 304 claims, totaling $2K in Medicaid payments from 2018–2024. This code was used for 259 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
$5.98
Providers Billing
2
National Spending
$2K
Avg/Median Ratio
1.00×
Normal distribution
Provider Coverage
We have 2 providers billing this code in our dataset. Individual provider breakdowns are available for top-spending procedure codes.