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See a sample rate comparisonHCPCS J0218 (Xenpozyme) 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.
Injection, olipudase alfa-rpcp, 1 mg
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Drugs, Administered by Injection |
| Common Place of Service | None 11 - Office |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for J0218 |
| Medicare Payment Limit | $393.661  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
| Related NDC Codes | • 58468-0050-01 - XENPOZYME (SDV,PF,LATEX-FREE) 20 MG |
National average reimbursement for HCPCS J0218 by major payers:
$370.43
$390.50
$413.12
$404.57
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HCPCS J0218
5 of 25 sample ratesHigher to lower in this preview
Neo-Perinatology Associates Of Orange County, Uci Medical Center
$1,726.23Published rateAdam Iwanski
The Everett Clinic, PLLC
$629.60Published rateSumner Regional Medical Center LLC, Sumner Regional Medical Center
$382.55Published rateBlanchard Valley Regional Health Center, Blanchard Valley Hospital
Blanchard Valley Regional Health Center
$381.57Published rateZachary Macdonald
New York City Health And Hospitals Corporation
$299.16Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS J0218 vs. Other Drugs, Administered by Injection Codes
The HCPCS J0218 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 J0218 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 |
|---|---|---|
| 58468-0050-01-NDC | Moderate | XENPOZYME (SDV,PF,LATEX-FREE) 20 MG |
| J0216-HCPCS | Low | Injection, alfentanil hydrochloride, 500 micrograms |
| J0218-HCPCS | Moderate | Injection, olipudase alfa-rpcp, 1 mg |
| J0219-HCPCS | Low | Injection, avalglucosidase alfa-ngpt, 4 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J0218. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J0218 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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