J7686
HCPCS Procedure Code
HCPCS code J7686 is the #1,651 most-billed Medicaid procedure code, with $16.8M in payments across 6K claims from 2018–2024. The national median cost per claim is $3,406.01.
Total Paid
$16.8M
0.00% of all spending
Total Claims
6K
Providers
3
Avg Cost/Claim
$3K
National Cost Distribution
How much do providers bill per claim for J7686? Based on 3 providers billing this code nationally.
Median
$3,406.01
Average
$2,862.88
Std Dev
$942.60
Max
$3,408.17
Percentile Distribution (Cost per Claim)
50% of providers bill between $2,590.23 and $3,407.09 per claim for this code.
90% bill between $2,100.77 and $3,407.74.
Top 1% bill above $3,408.13.
About This Procedure
HCPCS code J7686 was billed by 3 providers across 6K claims, totaling $16.8M in Medicaid payments from 2018–2024. This code was used for 4K 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
$3,406.01
Providers Billing
3
National Spending
$16.8M
Avg/Median Ratio
0.84×
Normal distribution
Provider Coverage
We have 3 providers billing this code in our dataset. Individual provider breakdowns are available for top-spending procedure codes.