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HCPCS J0642 (Khapzory) 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, levoleucovorin (khapzory), 0.5 mg
Key FactDetail
Service Type

Drugs Administered Other than Oral Method

Drugs, Administered by Injection

Common Place of Service

11 - Office

Complexity LevelLow
Medicaid Fee ScheduleView Medicaid rates for J0642
Medicare Payment Limit
$1.421BuyandBill.com
WAC Price
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Related NDC Codes

• 72893-0004-01 - KHAPZORY (PF,LYOPHILIZED) 175 MG

• 72893-0006-01 - KHAPZORY (PF,LYOPHILIZED) 300 MG


National average reimbursement for HCPCS J0642 by major payers:

bcbs

$1.51

uhc

$1.53

aetna

$1.62

cigna

$1.48

Compare published rates across providers.

Choose a payer to see a sample of rates for HCPCS J0642.

HCPCS J0642
5 of 25 sample ratesHigher to lower in this preview
  1. Sutter Delta Medical Center, Delta Memorial Hospital

    Sutter Bay Hospitals

    CAGeneral Acute Care HospitalNPI 1124135132Tax ID 94-0562680

    $4.26Published rate
  2. Alka Basil

    Northwestern Memorial Healthcare

    ILGeneral Acute Care HospitalNPI 1396908695Tax ID 36-3097297

    $1.72Published rate
  3. Minneapolis Vamc

    MNGeneral Acute Care HospitalNPI 1447209804Tax ID 41-0696270

    $1.53Published rate
  4. Green Clinic Surgical Hospital, LLC

    Green Clinic Surgical Hospital LLC

    LAGeneral Acute Care HospitalNPI 1700975083Tax ID 72-1517132

    $1.35Published rate
  5. Mercy Medical Center

    NYGeneral Acute Care HospitalNPI 1659330173Tax ID 11-1635088

    $0.68Published rate

National sample. Rates vary by location, specialty, and contract.

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HCPCS J0642 vs. Other Drugs, Administered by Injection Codes

The HCPCS J0642 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 J0642 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.

CodeComplexityDescription
72893-0004-01-NDCModerateKHAPZORY (PF,LYOPHILIZED) 175 MG
72893-0006-01-NDCModerateKHAPZORY (PF,LYOPHILIZED) 300 MG
J0641-HCPCSLowInjection, levoleucovorin, not otherwise specified, 0.5 mg
J0642-HCPCSLowInjection, levoleucovorin (khapzory), 0.5 mg

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J0642. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the J0642 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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