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See a sample rate comparisonHCPCS J0174 (Leqembi) 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.
Lecanemab-irmb, for intravenous injection, 1 mg
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Drugs, Administered by Injection |
| Common Place of Service | 11 - Office None |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for J0174 |
| Medicare Payment Limit | $1.324  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
| Related NDC Codes | • 62856-0212-01 - LEQEMBI (SDV,PF) 100 MG/1 ML • 62856-0215-01 - LEQEMBI (SDV,PF) 100 MG/1 ML |
National average reimbursement for HCPCS J0174 by major payers:
$1.42
$1.37
$1.47
$1.41
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HCPCS J0174
5 of 25 sample ratesHigher to lower in this preview
Katelyn Woolridge
$2.67Published rateRazan El Ramahi
Infectious Disease Doctors PA
$1.35Published rateMadhukanth Reddy
Infectious Diseases Consultants Of Texas PLLC
$1.35Published rateJosephine Ni
$1.31Published rateTexas Health Care, P.L.L.C.
Privia Medical Group Of North Texas
$1.31Published rate
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See a sample payer proposalHCPCS J0174 vs. Other Drugs, Administered by Injection Codes
The HCPCS J0174 code is part of the Drugs Administered Other than Oral Method services used for Drugs, Administered by Injection. 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 J0174 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 |
|---|---|---|
| 62856-0212-01-NDC | Moderate | LEQEMBI (SDV,PF) 100 MG/1 ML |
| 62856-0215-01-NDC | Moderate | LEQEMBI (SDV,PF) 100 MG/1 ML |
| J0174-HCPCS | Low | Lecanemab-irmb, for intravenous injection, 1 mg |
| J0178-HCPCS | Moderate | Injection, aflibercept, 1 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J0174. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J0174 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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