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See a sample rate comparisonHCPCS J1743 (Elaprase) 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, idursulfase, 1 mg
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Drugs, Administered by Injection |
| Common Place of Service | None 99 - Other POS |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for J1743 |
| Medicare Payment Limit | $558.456  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
| Related NDC Codes | • 54092-0700-01 - ELAPRASE (PF) 2 MG/ML |
National average reimbursement for HCPCS J1743 by major payers:
$561.99
$550.29
$584.80
$572.00
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HCPCS J1743
5 of 25 sample ratesHigher to lower in this preview
Hmh Hospitals Corporation
Hackensack Meridian Health Inc
$1,076.40Published rateWinston County Medical Foundation, Winston Medical Center
Winston County Medical Foundation
$595.80Published rateAdventist Health System-Sunbelt, Inc, Adventhealth Orlando
Adventist Health System-Sunbelt Inc
$544.91Published rateSeattle Vamc
$542.21Published rateDlp Haywood Regional Medical Center LLC, Haywood Hospice & Palliative Care
$490.42Published rate
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See a sample payer proposalHCPCS J1743 vs. Other Drugs, Administered by Injection Codes
The HCPCS J1743 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 J1743 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 |
|---|---|---|
| 54092-0700-01-NDC | Moderate | ELAPRASE (PF) 2 MG/ML |
| J1742-HCPCS | Moderate | Injection, ibutilide fumarate, 1 mg |
| J1743-HCPCS | Moderate | Injection, idursulfase, 1 mg |
| J1744-HCPCS | Low | Injection, icatibant, 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 J1743. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J1743 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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