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See a sample rate comparisonHCPCS J0597 (Berinert) 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, C-1 esterase inhibitor (human), Berinert, 10 units
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Drugs, Administered by Injection |
| Common Place of Service | None 99 - Other POS |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for J0597 |
| Medicare Payment Limit | $75.859  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J0597 by major payers:
$71.35
$70.96
$72.89
$72.57
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HCPCS J0597
5 of 25 sample ratesHigher to lower in this preview
Sutter Central Valley Hospitals, Memorial Medical Center Opt Pharmacy
Sutter Valley Hospitals
$163.67Published rateWest Penn Allegheny Health System Inc, The Western Pennsylvania Hospital
Highmark Health
$89.20Published rateSt Claire Medical Center Inc, St Claire Regional Medical Center
St Claire Medical Center Inc
$72.45Published rateSoutheast Hospital, Mercy Hospital Southeast
Southeast Hospital
$68.36Published ratePortercare Adventist Health System, Adventhealth Porter
Portercare Adventist Health System
$64.43Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS J0597 vs. Other Drugs, Administered by Injection Codes
The HCPCS J0597 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 J0597 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 |
|---|---|---|
| J0596-HCPCS | Low | Injection, C1 esterase inhibitor (recombinant), ruconest, 10 units |
| J0597-HCPCS | Low | Injection, C-1 esterase inhibitor (human), Berinert, 10 units |
| J0598-HCPCS | Low | Injection, C-1 esterase inhibitor (human), Cinryze, 10 units |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J0597. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J0597 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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