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See a sample rate comparisonHCPCS J1602 (Simponi Aria) 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, golimumab, 1 mg, for intravenous use
| 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 J1602 |
| Medicare Payment Limit | $11.039  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J1602 by major payers:
$12.99
$13.04
$14.76
$12.53
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HCPCS J1602
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$27.15Published rateKimya-Anhcina Nguyen
$12.34Published rateBranson Family Medicine Clinic, Skaggs Community Hospital
Skaggs Community Hospital Association
$11.80Published rateLeith Sawalha
Northern Arizona Healthcare Corporation
$11.36Published rateAdrienne Kurland
Arbor Medical Partners, LLC
$11.10Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS J1602 vs. Other Drugs, Administered by Injection Codes
The HCPCS J1602 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 J1602 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 |
|---|---|---|
| J1600-HCPCS | Low | Injection, gold sodium thiomalate, up to 50 mg |
| J1602-HCPCS | Low | Injection, golimumab, 1 mg, for intravenous use |
| J1610-HCPCS | Low | Injection, glucagon hydrochloride, per 1 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J1602. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J1602 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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