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See a sample rate comparisonHCPCS J1428 (Exondys 51) 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, eteplirsen, 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 11 - Office |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for J1428 |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J1428 by major payers:
$158.81
$168.38
$167.49
$169.58
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HCPCS J1428
5 of 25 sample ratesHigher to lower in this preview
Fairview Health Services, Fairview Lakes Regional Medical Center
Fairview Health Services
$305.54Published ratePhoenix Vamc
$164.80Published rateMount St. Mary'S Hospital Of Niagara Falls
Mount St Marys Hospital Of Niagara Falls
$164.80Published rateMount St. Mary'S Hospital Of Niagara Falls
Mount St Marys Hospital Of Niagara Falls
$164.80Published rateGulf Health Hospitals, Inc, Thomas Hospital
Gulf Health Hospitals Inc
$157.05Published rate
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See a sample payer proposalHCPCS J1428 vs. Other Drugs, Administered by Injection Codes
The HCPCS J1428 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 J1428 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 |
|---|---|---|
| J1427-HCPCS | Low | Injection, viltolarsen, 10 mg |
| J1428-HCPCS | Low | Injection, eteplirsen, 10 mg |
| J1429-HCPCS | Low | Injection, golodirsen, 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 J1428. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J1428 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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