#8062 of 11K

J7610

HCPCS Procedure Code

HCPCS code J7610 is the #8,062 most-billed Medicaid procedure code, with $7K in payments across 13K claims from 2018–2024. The national median cost per claim is $0.38. Costs vary widely — the 90th percentile is $10.41 per claim, 27.4× the median.

Total Paid

$7K

0.00% of all spending

Total Claims

13K

Providers

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for J7610? Based on 24 providers billing this code nationally.

Median

$0.38

Average

$2.43

Std Dev

$4.72

Max

$16.29

Percentile Distribution (Cost per Claim)

p10

$0.01

p25

$0.06

Median

$0.38

p75

$1.09

p90

$10.41

p95

$12.46

p99

$15.49

50% of providers bill between $0.06 and $1.09 per claim for this code.

90% bill between $0.01 and $10.41.

Top 1% bill above $15.49.

About This Procedure

HCPCS code J7610 was billed by 59 providers across 13K claims, totaling $7K in Medicaid payments from 2018–2024. This code was used for 12K 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

$0.38

Providers Billing

National Spending

$7K

Avg/Median Ratio

6.39×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for J7610

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1588804777	$3K	$12.81	33.7× median	Top 10%
2	1992073209	$2K	$16.29	42.9× median	Top 1%
3	1336328244	$525	$10.49	27.6× median	Top 10%
4	1699014365	$418	$0.80	2.1× median	Above Median
5	Childrens Hospital Of The Kings Daughters Inc Norfolk, VA · Social Worker, Clinical	$174	$10.22	26.9× median	Above 75th
6	1962668145	$123	$2.46	6.5× median	Above 75th
7	1427140615	$64	$0.07	0.2× median	Below Median
8	1811080526	$61	$1.16	3.0× median	Above 75th
9	1164497533	$54	$0.43	1.1× median	Above Median
10	1205266129	$32	$1.07	2.8× median	Above Median
11	1164482147	$23	$0.04	0.1× median	Below Median
12	1588624019	$14	$0.18	0.5× median	Below Median
13	New York Network Ipa Inc Brooklyn, NY · Exclusive Provider Organization	$10	$0.14	0.4× median	Below Median
14	1568056372	$8	$0.23	0.6× median	Below Median
15	1427372028	$7	$0.56	1.5× median	Above Median
16	1548424583	$7	$0.51	1.3× median	Above Median
17	1891775128	$6	$0.43	1.1× median	Above Median
18	1255375861	$4	$0.34	0.9× median	Below Median
19	1457450017	$3	$0.02	0.0× median	Below Median
20	1942669916	$1	$0.10	0.3× median	Below Median

Showing top 20 of 59 providers billing this code

Related Procedures

J7605$10.4M J7606$8.3M J7613Albuterol inhalation solution, concentrated, per milligram$3.2M J7620$3.1M J7611Albuterol inhalation solution, non-concentrated, per milligram$1.1M

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