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See a sample rate comparisonHCPCS J0638 (Ilaris) Fee Schedule
Last Verified: September 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, canakinumab, 1 mg
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Drugs, Administered by Injection |
| Common Place of Service | 11 - Office None 99 - Other POS |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for J0638 |
| Medicare Payment Limit | $141.604  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
| Related NDC Codes | • 00078-0734-61 - ILARIS (PF) 150 MG/1 ML |
National average reimbursement for HCPCS J0638 by major payers:
$129.95
$131.28
$137.70
$135.63
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HCPCS J0638
5 of 25 sample ratesHigher to lower in this preview
Maria Montenegro
Providence Medical Foundation
$152.57Published rateIsaac Perez
Flower Mound Dermatology
$124.33Published rateTexas Health Care, P.L.L.C.
$122.06Published rateParkinsons Restless Legs & Movement Disorder Specialists PLLC
Parkinsons Restless Legs Movement Disorder Specialists PLLC
$122.06Published rateAnyplace Healthcare Organization
$119.82Published rate
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See a sample payer proposalHCPCS J0638 vs. Other Drugs, Administered by Injection Codes
The HCPCS J0638 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 J0638 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 |
|---|---|---|
| 00078-0734-61-NDC | Moderate | ILARIS (PF) 150 MG/1 ML |
| J0637-HCPCS | Low | Injection, caspofungin acetate, 5 mg |
| J0638-HCPCS | Low | Injection, canakinumab, 1 mg |
| J0640-HCPCS | Low | Injection, leucovorin calcium, per 50 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J0638. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J0638 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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