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See a sample rate comparisonHCPCS J0270 (Prostin Vr Pediatric) 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, alprostadil, 1.25 mcg (code may be used for Medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Drugs, Administered by Injection |
| Common Place of Service | 11 - Office None 24 - Ambulatory Surgical Center |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for J0270 |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
| Related NDC Codes | • 00009-0215-05 - PROSTIN VR PEDIATRIC NOVAPLUS (LATEX-FREE) 0.5 MG/1 ML • 00009-3169-06 - PROSTIN VR PEDIATRIC (AMP,5X1ML) 0.5 MG/ML • 00009-3701-05 - CAVERJECT (VIAL) 20 MCG • 00009-5181-01 - CAVERJECT IMPULSE (SYSTEM) 10 MCG • 00009-5182-01 - CAVERJECT IMPULSE (SYSTEM) 20 MCG |
National average reimbursement for HCPCS J0270 by major payers:
$6.87
$9.90
$10.59
$7.52
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HCPCS J0270
5 of 25 sample ratesHigher to lower in this preview
Allina Health System, United Hospital
Allina Health System
$23.55Published rateHutchinson Health, Hutchinson Health Hospital
Hutchinson Health
$12.22Published rateSteward Holy Family Hospital, Inc.
$10.27Published rateOnslow Memorial Hospital Inc, Onslow Memorial Hospital
Onslow Memorial Hospital Inc
$10.27Published rateUniversity Of California San Francisco Medical Center, Ucsf Medical Center
$0.75Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS J0270 vs. Other Drugs, Administered by Injection Codes
The HCPCS J0270 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 J0270 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 |
|---|---|---|
| 00009-0215-05-NDC | Moderate | PROSTIN VR PEDIATRIC NOVAPLUS (LATEX-FREE) 0.5 MG/1 ML |
| 00009-3169-06-NDC | Moderate | PROSTIN VR PEDIATRIC (AMP,5X1ML) 0.5 MG/ML |
| 00009-3701-05-NDC | Moderate | CAVERJECT (VIAL) 20 MCG |
| J0270-HCPCS | Low | Injection, alprostadil, 1.25 mcg (code may be used for Medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J0270. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J0270 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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