J7609
HCPCS Procedure Code
HCPCS code J7609 is the #7,734 most-billed Medicaid procedure code, with $11K in payments across 23K claims from 2018–2024. The national median cost per claim is $0.15. Costs vary widely — the 90th percentile is $1.48 per claim, 9.9× the median.
Total Paid
$11K
0.00% of all spending
Total Claims
23K
Providers
90
Avg Cost/Claim
$0
National Cost Distribution
How much do providers bill per claim for J7609? Based on 37 providers billing this code nationally.
Median
$0.15
Average
$3.85
Std Dev
$17.56
Max
$105.42
Percentile Distribution (Cost per Claim)
50% of providers bill between $0.06 and $0.58 per claim for this code.
90% bill between $0.01 and $1.48.
Top 1% bill above $75.65.
About This Procedure
HCPCS code J7609 was billed by 90 providers across 23K claims, totaling $11K in Medicaid payments from 2018–2024. This code was used for 18K 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
$0.15
Providers Billing
37
National Spending
$11K
Avg/Median Ratio
25.67×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for J7609
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1578599809 | $4K |
| 2 | West Virginia University Hospitals, Inc Morgantown, WV · Clinical Medical Laboratory | $3K |
| 3 | 1053563304 | $2K |
| 4 | 1861756785 | $684 |
| 5 | 1811080526 | $494 |
| 6 | 1679582829 | $210 |
| 7 | 1770693939 | $166 |
| 8 | 1407828429 | $124 |
| 9 | 1134569049 | $104 |
| 10 | 1215191184 | $61 |
| 11 | 1346374238 | $58 |
| 12 | 1679651921 | $32 |
| 13 | 1356526776 | $32 |
| 14 | 1184793986 | $23 |
| 15 | 1699962431 | $19 |
| 16 | 1124013230 | $16 |
| 17 | 1447519715 | $14 |
| 18 | 1952393043 | $14 |
| 19 | 1356496020 | $10 |
| 20 | 1629458468 | $9 |
Showing top 20 of 90 providers billing this code