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See a sample rate comparisonHCPCS J0801 (H.P. Acthar) Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Injection, corticotropin (acthar gel), up to 40 units
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Drugs, Administered by Injection |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for J0801 |
| Medicare Payment Limit | $4134.622  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J0801 by major payers:
$4,356.75
$4,956.60
$8,095.94
$4,838.81
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HCPCS J0801
5 of 25 sample ratesHigher to lower in this preview
Prohealth Waukesha Memorial Hospital, Inc.
Prohealth Waukesha Memorial Hospital Inc
$9,583.04Published ratePrisma Health-Upstate, Prisma Health Cancer Inst-Greer
Prisma Health-University Medical Group
$4,125.08Published rateSisters Of Charity Hospital Of Buffalo New York
$3,827.83Published rateHardin County General Hospital, Hardin Medical Center
Hardin County General Hospital
$3,750.08Published rateNew York City Health And Hospitals Corporation, Kings County Hospital Center
New York City Health And Hospitals Corporation
$3,001.02Published rate
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See a sample payer proposalHCPCS J0801 vs. Other Drugs, Administered by Injection Codes
The HCPCS J0801 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 J0801 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 |
|---|---|---|
| J0801-HCPCS | High | Injection, corticotropin (acthar gel), up to 40 units |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J0801. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J0801 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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