J7131
HCPCS Procedure Code
HCPCS code J7131 is the #4,235 most-billed Medicaid procedure code, with $724K in payments across 16K claims from 2018–2024. The national median cost per claim is $34.36.
Total Paid
$724K
0.00% of all spending
Total Claims
16K
Providers
12
Avg Cost/Claim
$44
National Cost Distribution
How much do providers bill per claim for J7131? Based on 10 providers billing this code nationally.
Median
$34.36
Average
$27.61
Std Dev
$20.64
Max
$49.19
Percentile Distribution (Cost per Claim)
50% of providers bill between $5.77 and $44.61 per claim for this code.
90% bill between $0.14 and $48.08.
Top 1% bill above $49.08.
About This Procedure
HCPCS code J7131 was billed by 12 providers across 16K claims, totaling $724K in Medicaid payments from 2018–2024. This code was used for 15K 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
$34.36
Providers Billing
10
National Spending
$724K
Avg/Median Ratio
0.80×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J7131
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1013913458 | $547K |
| 2 | 1114113115 | $140K |
| 3 | 1629214689 | $23K |
| 4 | 1275612673 | $5K |
| 5 | 1770583387 | $4K |
| 6 | 1376513200 | $3K |
| 7 | 1801825005 | $867 |
| 8 | 1891890158 | $403 |
| 9 | 1225168024 | $13 |
| 10 | 1861402935 | $0 |
| 11 | 1114333127 | $0 |
| 12 | 1902897820 | $0 |
Showing top 12 of 12 providers billing this code