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See a sample rate comparisonHCPCS J1306 (Leqvio) 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, inclisiran, 1 mg
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Drugs, Administered by Injection |
| Common Place of Service | 11 - Office None |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for J1306 |
| Medicare Payment Limit | $12.318  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J1306 by major payers:
$13.57
$12.47
$13.60
$12.90
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HCPCS J1306
5 of 25 sample ratesHigher to lower in this preview
Kimberly Russell
Scott & White Hospital
$23.46Published rateWilliam Rutledge
Orange Medical Surgical Associates,
$12.21Published rateJaime Duarte
Canal Family And Industrial Me
$12.13Published rateSteven Zierer
Arizona Digestive Health, PC
$12.11Published rateInternal Medicine South
Internal Medicine South, L.L.C.
$9.69Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS J1306 vs. Other Drugs, Administered by Injection Codes
The HCPCS J1306 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 J1306 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 |
|---|---|---|
| J1305-HCPCS | Low | Injection, evinacumab-dgnb, 5mg |
| J1306-HCPCS | Low | Injection, inclisiran, 1 mg |
| J1320-HCPCS | Low | Injection, amitriptyline HCl, up to 20 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J1306. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J1306 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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