#2690 of 11K

J7626

HCPCS Procedure Code

HCPCS code J7626 is the #2,690 most-billed Medicaid procedure code, with $4.1M in payments across 342K claims from 2018–2024. The national median cost per claim is $9.81. Costs vary widely — the 90th percentile is $31.61 per claim, 3.2× the median.

Total Paid

$4.1M

0.00% of all spending

Total Claims

342K

Providers

119

Avg Cost/Claim

$12

National Cost Distribution

How much do providers bill per claim for J7626? Based on 98 providers billing this code nationally.

Median

$9.81

Average

$13.37

Std Dev

$14.97

Max

$87.28

Percentile Distribution (Cost per Claim)

p10

$0.50

p25

$1.84

Median

$9.81

p75

$21.76

p90

$31.61

p95

$38.93

p99

$66.48

50% of providers bill between $1.84 and $21.76 per claim for this code.

90% bill between $0.50 and $31.61.

Top 1% bill above $66.48.

About This Procedure

HCPCS code J7626 was billed by 119 providers across 342K claims, totaling $4.1M in Medicaid payments from 2018–2024. This code was used for 276K 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

$9.81

Providers Billing

National Spending

$4.1M

Avg/Median Ratio

1.36×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J7626

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1780748939	$1.5M	$10.26	1.0× median	Above Median
2	1003970260	$819K	$12.92	1.3× median	Above Median
3	1275697435	$453K	$12.00	1.2× median	Above Median
4	1114081270	$372K	$29.52	3.0× median	Above 75th
5	1134698418	$228K	$8.21	0.8× median	Below Median
6	1114943610	$171K	$16.10	1.6× median	Above Median
7	1194725705	$145K	$14.93	1.5× median	Above Median
8	1912060740	$104K	$22.98	2.3× median	Above 75th
9	1730177668	$58K	$23.36	2.4× median	Above 75th
10	1568465938	$58K	$11.80	1.2× median	Above Median
11	Super Care Inc City Of Industry, CA · Durable Medical Equipment & Medical Supplies	$57K	$65.84	6.7× median	Top 10%
12	1588830533	$25K	$28.85	2.9× median	Above 75th
13	1285621193	$20K	$17.07	1.7× median	Above Median
14	1730265331	$14K	$32.00	3.3× median	Top 10%
15	1649209305	$14K	$15.18	1.5× median	Above Median
16	1982653523	$10K	$21.64	2.2× median	Above Median
17	1821030636	$9K	$40.22	4.1× median	Top 10%
18	Boston Medical Center Corporation Boston, MA · General Acute Care Hospital	$8K	$6.23	0.6× median	Below Median
19	1063869238	$7K	$4.19	0.4× median	Below Median
20	1891897096	$7K	$3.17	0.3× median	Below Median

Showing top 20 of 119 providers billing this code

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J7620$3.1M J7633$2K J7624$75 J7627$2 J7616$0

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