J7686 HCPCS code: Treprostinil, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, 1.74 mg
J7686 is the HCPCS Level II code for treprostinil, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, 1.74 mg. In 2024 Medicare paid an average of $581.48 per service for J7686 across 250,698 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 28 per day on DME suppliers. Medicare volume fell 33% from 2022 to 2024 (372,805 to 250,698 services). In 2024, 31 suppliers billed Medicare for J7686 (purchases), serving 1,223 beneficiaries; Florida, California, Texas accounted for 23% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | D1G — Drugs administered through DME |
| Added | 2011-01-01 |
| Last action effective | 2011-01-01 |
Who bills J7686 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 31 |
| Referring clinicians | 595 |
| Medicare beneficiaries | 1,223 |
| States with claims | 45 |
| Share of services in top 3 states (Florida, California, Texas) | 23% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 34 | 1,780 |
| 2023 | 32 | 1,490 |
| 2024 | 31 | 1,223 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J7686, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 372,805 | 1,780 | $696.02 | $548.68 |
| 2023 | 287,259 | 1,490 | $727.73 | $569.99 |
| 2024 | 250,698 | 1,223 | $742.23 | $581.48 |
States with the most J7686 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 20,948 | $581.60 |
| California | 19,476 | $581.08 |
| Texas | 18,254 | $581.96 |
| Massachusetts | 16,413 | $582.01 |
| Pennsylvania | 14,114 | $581.35 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 28 | Clinical: Data |
| practitioner claims | 1 | Prescribing Information |
Medicare policy articles for this code
- A52466: Nebulizers - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (215 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| A15.0 | Tuberculosis of lung | 1 |
| A22.1 | Pulmonary anthrax | 1 |
| A37.01 | Whooping cough due to Bordetella pertussis with pneumonia | 1 |
| A37.11 | Whooping cough due to Bordetella parapertussis with pneumonia | 1 |
| A37.81 | Whooping cough due to other Bordetella species with pneumonia | 1 |
| A37.91 | Whooping cough, unspecified species with pneumonia | 1 |
| A48.1 | Legionnaires' disease | 1 |
| B20 | Human immunodeficiency virus [HIV] disease | 1 |
| B25.0 | Cytomegaloviral pneumonitis | 1 |
| B44.0 | Invasive pulmonary aspergillosis | 1 |
Showing 10 of 215. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J7686
- 2011-01-01: J7686 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code J7686?
J7686 is the HCPCS Level II code for treprostinil, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, 1.74 mg. Short descriptor: "Treprostinil, non-comp unit".
How much does Medicare pay for J7686?
In 2024, the average Medicare payment was $581.48 per service (average allowed $742.23).
Does Medicare cover J7686?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for J7686?
Medicare policy articles that cite J7686 list 215 covered ICD-10-CM diagnosis codes across 1 article. The most cited include A15.0 (Tuberculosis of lung), A22.1 (Pulmonary anthrax), A37.01 (Whooping cough due to Bordetella pertussis with pneumonia). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J7686 can be billed per day?
28 on DME suppliers; 1 on practitioner claims (NCCI medically unlikely edits).
Related J76 codes
- J7601 — Ensifentrine, inhalation suspension, fda approved final product, non-compounded, administered through dme, unit dose form, 3 mg
- J7604 — Acetylcysteine, inhalation solution, compounded product, administered through dme, unit dose form, per gram
- J7605 — Arformoterol, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 15 micrograms
- J7606 — Formoterol fumarate, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 20 micrograms
- J7607 — Levalbuterol, inhalation solution, compounded product, administered through dme, concentrated form, 0.5 mg
- J7608 — Acetylcysteine, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per gram
- J7609 — Albuterol, inhalation solution, compounded product, administered through dme, unit dose, 1 mg
- J7610 — Albuterol, inhalation solution, compounded product, administered through dme, concentrated form, 1 mg
- J7611 — Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg
- J7612 — Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 0.5 mg
- J7613 — Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg
- J7614 — Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 0.5 mg
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under J7686
- Watch J7686 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J7686
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.