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See a sample rate comparisonHCPCS J1426 (Amondys 45) 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, casimersen, 10 mg
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Drugs, Administered by Injection |
| Common Place of Service | 99 - Other POS None |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for J1426 |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J1426 by major payers:
$150.61
$168.34
$167.22
$169.40
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HCPCS J1426
5 of 25 sample ratesHigher to lower in this preview
Mainegeneral Medical Center, Mainegeneral Speciality Care
Mainegeneral Health
$238.96Published rateLior Shabtai
North Shore-Lij Medical PC
$174.69Published rateAnne Arundel Medical Center
$164.80Published rateNew York-Presbyterian/Lawrence Hospital
Lawrence Medical Associates PC
$164.80Published rateKing'S Daughters Medical Center
Kings Daughters Medical Center
$155.80Published rate
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See a sample payer proposalHCPCS J1426 vs. Other Drugs, Administered by Injection Codes
The HCPCS J1426 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 J1426 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 |
|---|---|---|
| J1411-HCPCS | High | Injection, etranacogene dezaparvovec-drlb, per therapeutic dose |
| J1426-HCPCS | Low | Injection, casimersen, 10 mg |
| J1427-HCPCS | Low | Injection, viltolarsen, 10 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J1426. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J1426 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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