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See a sample rate comparisonHCPCS J1203 (Pombiliti) 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, cipaglucosidase alfa-atga, 5 mg
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Drugs, Administered by Injection |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for J1203 |
| Medicare Payment Limit | $91.213  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J1203 by major payers:
$94.52
$108.49
$175.16
$105.67
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HCPCS J1203
5 of 25 sample ratesHigher to lower in this preview
Saint Thomas Stones River Hospital, LLC, Ascension Saint Thomas Stones River
$189.50Published rateState Of Mississippi-University Of Mississippi Medical Center, University Of Mississippi Center-Grenada
$114.48Published rateHenry Ford Macomb Hospital Corporation, Henry Ford Macomb Hospital
Henry Ford Macomb Hospital Corporation
$92.05Published rateEl Campo Memorial Hospital
$88.13Published rateHoly Family Memorial Inc, Froedtert Holy Family Memorial Hospital
Holy Family Memorial Inc
$88.05Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS J1203 vs. Other Drugs, Administered by Injection Codes
The HCPCS J1203 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 J1203 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 |
|---|---|---|
| J1203-HCPCS | Low | Injection, cipaglucosidase alfa-atga, 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 J1203. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J1203 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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