J7642
HCPCS Procedure Code
HCPCS code J7642 is the #7,811 most-billed Medicaid procedure code, with $10K in payments across 24K claims from 2018–2024. The national median cost per claim is $0.24. Costs vary widely — the 90th percentile is $11.00 per claim, 45.8× the median.
Total Paid
$10K
0.00% of all spending
Total Claims
24K
Providers
20
Avg Cost/Claim
$0
National Cost Distribution
How much do providers bill per claim for J7642? Based on 14 providers billing this code nationally.
Median
$0.24
Average
$2.71
Std Dev
$5.27
Max
$15.92
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.10 and $0.83 per claim for this code.
90% bill between $0.01 and $11.00.
Top 1% bill above $15.59.
About This Procedure
HCPCS code J7642 was billed by 20 providers across 24K claims, totaling $10K in Medicaid payments from 2018–2024. This code was used for 23K 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
$0.24
Providers Billing
14
National Spending
$10K
Avg/Median Ratio
11.29×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J7642
| # | Provider | Total Paid |
|---|---|---|
| 1 | Children's Hospital Washington, DC · General Acute Care Hospital Children | $5K |
| 2 | 1821194978 | $2K |
| 3 | 1699986331 | $1K |
| 4 | 1588875967 | $281 |
| 5 | 1548374549 | $125 |
| 6 | The New York And Presbyterian Hospital New York, NY · General Acute Care Hospital | $84 |
| 7 | 1922087915 | $65 |
| 8 | Newyork-presbyterian-queens Flushing, NY · General Acute Care Hospital | $58 |
| 9 | The New York And Presbyterian Hospital New York, NY · General Acute Care Hospital | $38 |
| 10 | 1811080526 | $36 |
| 11 | 1821099474 | $29 |
| 12 | 1245224682 | $16 |
| 13 | St. Barnabas Hospital Bronx, NY · General Acute Care Hospital | $12 |
| 14 | 1285845982 | $10 |
| 15 | 1417124959 | $0 |
| 16 | 1194766543 | $0 |
| 17 | 1306921887 | $0 |
| 18 | 1225278997 | $0 |
| 19 | 1669462362 | $0 |
| 20 | 1487865184 | $0 |
Showing top 20 of 20 providers billing this code