J7042
HCPCS Procedure Code
HCPCS code J7042 is the #3,547 most-billed Medicaid procedure code, with $1.5M in payments across 226K claims from 2018–2024. The national median cost per claim is $1.10. Costs vary widely — the 90th percentile is $18.68 per claim, 17.0× the median.
Total Paid
$1.5M
0.00% of all spending
Total Claims
226K
Providers
288
Avg Cost/Claim
$7
National Cost Distribution
How much do providers bill per claim for J7042? Based on 216 providers billing this code nationally.
Median
$1.10
Average
$7.84
Std Dev
$20.29
Max
$166.07
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.26 and $4.48 per claim for this code.
90% bill between $0.06 and $18.68.
Top 1% bill above $103.56.
About This Procedure
HCPCS code J7042 was billed by 288 providers across 226K claims, totaling $1.5M in Medicaid payments from 2018–2024. This code was used for 171K 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
$1.10
Providers Billing
216
National Spending
$1.5M
Avg/Median Ratio
7.13×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J7042
| # | Provider | Total Paid |
|---|---|---|
| 1 | The Nemours Foundation Orlando, FL · General Acute Care Hospital Children | $372K |
| 2 | Cook Children's Medical Center Fort Worth, TX · General Acute Care Hospital Children | $287K |
| 3 | Upmc Children's Hospital Of Pittsburgh Pittsburgh, PA · Clinic/Center | $154K |
| 4 | 1649726738 | $116K |
| 5 | Henry Ford Health System Detroit, MI · General Acute Care Hospital | $92K |
| 6 | 1487868097 | $77K |
| 7 | 1114367497 | $50K |
| 8 | 1174500458 | $47K |
| 9 | 1700831724 | $33K |
| 10 | 1528169125 | $19K |
| 11 | 1346297843 | $17K |
| 12 | Texas Children's Hospital Houston, TX · General Acute Care Hospital Children | $17K |
| 13 | Owensboro Health Inc Owensboro, KY · General Acute Care Hospital | $13K |
| 14 | Pikeville Medical Center Inc Pikeville, KY · General Acute Care Hospital | $12K |
| 15 | Norton Hospitals, Inc Louisville, KY · General Acute Care Hospital | $12K |
| 16 | Norton Hospitals Inc Louisville, KY · General Acute Care Hospital | $9K |
| 17 | The New York And Presbyterian Hospital New York, NY · General Acute Care Hospital | $8K |
| 18 | 1356444814 | $8K |
| 19 | Vhs Childrens Hospital Of Michigan Inc Detroit, MI · Clinic/Center, Ambulatory Surgical | $7K |
| 20 | Scottish Rite Children's Medical Center Atlanta, GA · Pediatrics Pediatric Hematology-Oncology | $6K |
Showing top 20 of 288 providers billing this code