#6175 of 11K

J7699

HCPCS Procedure Code

HCPCS code J7699 is the #6,175 most-billed Medicaid procedure code, with $87K in payments across 7,654 claims from 2018–2024. The national median cost per claim is $3.13. Costs vary widely — the 90th percentile is $93.91 per claim, 30.0× the median.

Total Paid

$87K

0.00% of all spending

Total Claims

7,654

Providers

Avg Cost/Claim

$11

National Cost Distribution

How much do providers bill per claim for J7699? Based on 18 providers billing this code nationally.

Median

$3.13

Average

$36.48

Std Dev

$54.25

Max

$194.59

Percentile Distribution (Cost per Claim)

p10

$0.07

p25

$0.29

Median

$3.13

p75

$74.14

p90

$93.91

p95

$111.20

p99

$177.92

50% of providers bill between $0.29 and $74.14 per claim for this code.

90% bill between $0.07 and $93.91.

Top 1% bill above $177.92.

About This Procedure

HCPCS code J7699 was billed by 38 providers across 7,654 claims, totaling $87K in Medicaid payments from 2018–2024. This code was used for 6,734 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

$3.13

Providers Billing

National Spending

$87K

Avg/Median Ratio

11.65×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for J7699

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1194725705	$37K	$96.49	30.8× median	Top 10%
2	1043293608	$24K	$47.30	15.1× median	Above Median
3	Upmc Children's Hospital Of Pittsburgh Pittsburgh, PA · Clinic/Center	$9K	$42.34	13.5× median	Above Median
4	1720096019	$7K	$83.09	26.5× median	Above 75th
5	Super Care Inc City Of Industry, CA · Durable Medical Equipment & Medical Supplies	$3K	$194.59	62.2× median	Top 1%
6	Procare Pharmacy Direct, Llc. Monroeville, PA · Pharmacy, Community/Retail Pharmacy	$3K	$92.80	29.6× median	Above 75th
7	1275697435	$2K	$84.76	27.1× median	Above 75th
8	Childrens Hospital Of The Kings Daughters Inc Norfolk, VA · Social Worker, Clinical	$1K	$2.35	0.7× median	Below Median
9	1346374238	$477	$3.91	1.3× median	Above Median
10	Children's Hospital Washington, DC · General Acute Care Hospital Children	$234	$0.34	0.1× median	Below Median
11	Connecticut Children's Medical Center Hartford, CT · General Acute Care Hospital, Children	$192	$0.26	0.1× median	Below Median
12	Children's Hospital Of Wisconsin, Inc. Milwaukee, WI · Dentist, Pediatric Dentistry	$111	$0.08	0.0× median	Below Median
13	1154400232	$83	$6.92	2.2× median	Above Median
14	1972523348	$25	$0.07	0.0× median	Below Median
15	1477669885	$18	$0.68	0.2× median	Below Median
16	1518042175	$15	$0.30	0.1× median	Below Median
17	1497106504	$4	$0.29	0.1× median	Below Median
18	Inova Health Care Services Falls Church, VA · Clinic/Center, Rehabilitation, Substance Use Disorder	$3	$0.00	0.0× median	Below Median
19	1306883228	$0	$0.00	0.0× median	Below Median
20	1861466153	$0	$0.00	0.0× median	Below Median

Showing top 20 of 38 providers billing this code

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