J7638
HCPCS Procedure Code
HCPCS code J7638 is the #8,625 most-billed Medicaid procedure code, with $2K in payments across 2,451 claims from 2018–2024. The national median cost per claim is $0.07. Costs vary widely — the 90th percentile is $7.50 per claim, 107.1× the median.
Total Paid
$2K
0.00% of all spending
Total Claims
2,451
Providers
9
Avg Cost/Claim
$1
National Cost Distribution
How much do providers bill per claim for J7638? Based on 7 providers billing this code nationally.
Median
$0.07
Average
$2.65
Std Dev
$5.08
Max
$13.85
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.05 and $2.28 per claim for this code.
90% bill between $0.03 and $7.50.
Top 1% bill above $13.21.
About This Procedure
HCPCS code J7638 was billed by 9 providers across 2,451 claims, totaling $2K in Medicaid payments from 2018–2024. This code was used for 2,065 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
$0.07
Providers Billing
7
National Spending
$2K
Avg/Median Ratio
37.86×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J7638
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1114009339 | $2K |
| 2 | 1588804777 | $180 |
| 3 | 1104830900 | $118 |
| 4 | 1881793743 | $24 |
| 5 | 1649991043 | $19 |
| 6 | 1679771703 | $13 |
| 7 | 1801085022 | $0 |
| 8 | 1689728735 | $0 |
| 9 | 1194819920 | $0 |
Showing top 9 of 9 providers billing this code