J9316
HCPCS Procedure Code
HCPCS code J9316 is the #3,060 most-billed Medicaid procedure code, with $2.6M in payments across 576 claims from 2018–2024. The national median cost per claim is $5,381.69.
Total Paid
$2.6M
0.00% of all spending
Total Claims
576
Providers
4
Avg Cost/Claim
$5K
National Cost Distribution
How much do providers bill per claim for J9316? Based on 4 providers billing this code nationally.
Median
$5,381.69
Average
$5,144.11
Std Dev
$2,118.43
Max
$7,356.14
Percentile Distribution (Cost per Claim)
50% of providers bill between $4,060.85 and $6,464.96 per claim for this code.
90% bill between $3,098.48 and $6,999.67.
Top 1% bill above $7,320.50.
About This Procedure
HCPCS code J9316 was billed by 4 providers across 576 claims, totaling $2.6M in Medicaid payments from 2018–2024. This code was used for 369 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
$5,381.69
Providers Billing
4
National Spending
$2.6M
Avg/Median Ratio
0.96×
Normal distribution
Provider Coverage
We have 4 providers billing this code in our dataset. Individual provider breakdowns are available for top-spending procedure codes.