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See a sample rate comparisonHCPCS J7640 (Formoterol) Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Formoterol, inhalation solution, compounded product, administered through DME, unit dose form, 12 micrograms
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Inhalation Solutions |
| Common Place of Service | 11 - Office 20 - Urgent Care Facility None |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for J7640 |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
| Related NDC Codes | • 51927-3643-00 - FORMOTEROL FUMARATE (DIHYDRATE) • 62991-2516-01 - FORMOTEROL FUMARATE • 62991-2516-03 - FORMOTEROL FUMARATE |
National average reimbursement for HCPCS J7640 by major payers:
$5.24
$1.55
$3.00
$1.74
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HCPCS J7640
5 of 25 sample ratesHigher to lower in this preview
The Medical Center Inc, Piedmont Columbus Regional Midtown
The Medical Center Inc
$2.20Published rateEmad Hanna
New York City Health And Hospitals Corporation
$1.61Published rateKalispell Regional Medical Center Inc, Logan Health Medical Center
Kalispell Regional Medical Center Inc
$1.51Published rateJohnson Memorial Hospital, Johnson Memorial Hospital
Johnson Memorial Hospital
$1.51Published ratePrisma Health-Blount Memorial Hospital, Inc, Blount Memorial Hospital
$1.28Published rate
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See a sample payer proposalHCPCS J7640 vs. Other Inhalation Solutions Codes
The HCPCS J7640 code is part of the Drugs Administered Other than Oral Method services used for Inhalation Solutions. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS J7640 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 51927-3643-00-NDC | Moderate | FORMOTEROL FUMARATE (DIHYDRATE) |
| 62991-2516-01-NDC | Moderate | FORMOTEROL FUMARATE |
| 62991-2516-03-NDC | Moderate | FORMOTEROL FUMARATE |
| J7640-HCPCS | Low | Formoterol, inhalation solution, compounded product, administered through DME, unit dose form, 12 micrograms |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J7640. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J7640 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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