HCPCS J0174 (Leqembi) Fee Schedule
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.
| 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 |
| 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
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS J0174 | ||||||
United | J0174 | $1.31 | 1376893578 - HEALTHPLUS IMAGING OF TEXAS LLC | 455121443 - HEALTHPLUS IMAGING OF TEXAS LLC | TX | Multi-Specialty Group (193200000X) |
United | J0174 | $1.31 | 1639717382 - LEGACY MEDICAL CENTER, PLLC | 843447393 - LEGACY MEDICAL CENTER PLLC | TX | Physical Medicine & Rehabilitation Physician (208100000X) |
United | J0174 | $1.35 | 1073066239 - THE UNIVERSITY OF TEXAS AT AUSTIN | 746000203 | TX | General Practice Physician (208D00000X) |
United | J0174 | $1.35 | 1669503363 - RICHARD MCCONNELL | 751945000 - RICHARD F MCCONNELL JR MD | TX | Allergy & Immunology Physician (207K00000X) |
United | J0174 | $1.38 | 1073931812 - DANIELLE APPLEBAUM | 822518776 - ELITE DERMATOLOGY PLLC | TX | Dermatology Physician (207N00000X) |
United | J0174 | $1.35 | 1124468855 - DFW OBA PLLC | 462901905 | TX | Anesthesiology Physician (207L00000X) |
United | J0174 | $3.05 | 1124612387 - BHS PHYSICIANS NETWORK, INC. | 203059260 - BHS PHYSICIANS NETWORK, INC | TX | Pediatrics Physician (208000000X) |
United | J0174 | $2.67 | 1851788434 - KATELYN WOOLRIDGE | 720276883 | TX | Dermatology Physician (207N00000X) |
United | J0174 | $1.31 | 1578585337 - SHILPA CHITNIS | 756002868 | TX | Neurology Physician (2084N0400X) |
United | J0174 | $1.35 | 1376805069 - BRIAN JAMESON | 741109643 - ASCENSION SETON | TX | Family Medicine Physician (207Q00000X) |
United | J0174 | $4.35 | 1417036799 - ISABELLA GYENING | 760386391 - KELSEY-SEYBOLD MEDICAL GROUP PLLC | TX | Dermatology Physician (207N00000X) |
United | J0174 | $1.31 | 1235162777 - EAST TEXAS MEDICAL SPECIALISTS PLLC | 721580690 - EAST TEXAS MEDICAL SPECIALISTS PLLC | TX | Emergency Medicine Physician (207P00000X) |
United | J0174 | $1.35 | 1730584608 - WE CARE MOBILE HEALTH SERVICES, PLLC | 472133400 - WE CARE MOBILE HEALTH SERVICES, LLC | TX | Family Medicine Physician (207Q00000X) |
United | J0174 | $1.35 | 1902298110 - WOMEN SPECIALISTS OF CLEAR LAKE, PLLC | 300852873 - WOMEN SPECIALISTS OF CLEAR LAKE PLLC | TX | Nurse Practitioner (363L00000X) |
United | J0174 | $1.35 | 1447756580 - PRECISE TELEHEALTH OF TEXAS PLLC | 822665293 - PRECISE TELEHEALTH OF TEXAS PLLC | TX | Multi-Specialty Group (193200000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS 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 |
| J0173-HCPCS | Low | Injection, epinephrine (belcher) not therapeutically equivalent to j0171, 0.1 mg |
| J0174-HCPCS | Low | Injection, lecanemab-irmb, 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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