HCPCS J1815 (Apidra) Fee Schedule

HCPCS J1815 is classified under Drugs Administered Other than Oral Method, in the Drugs, Administered by Injection subgroup.

Injection, insulin, per 5 units

Key Fact	Detail
Service Type	Drugs Administered Other than Oral Method Drugs, Administered by Injection
Common Place of Service	11Office
Surgery Center Payment (ASC)	N1 - Packaged; no separate payment
Common Revenue Codes	0636 0250Sign up to view all 4
Medicaid Fee Schedule	$0.515 median of the 8 states in the free previewView Medicaid rates for J1815
WAC Price	Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com
Related NDC Codes	• 00002751101 - Humalog Mix75/25 (Insulin lispro) 100 [iU]/mL, injection, suspension • 00002751199 - Humalog Mix75/25 (Insulin lispro) 100 [iU]/mL, injection, suspension • 00002751201 - Humalog Mix50/50 (Insulin lispro) 100 [iU]/mL, injection, suspension • 00002751299 - Humalog Mix50/50 (Insulin lispro) 100 [iU]/mL, injection, suspension • 00002751659 - Humalog (Insulin lispro) 100 [iU]/mL, injection, solution

National average reimbursement for HCPCS J1815 by major payers:

$0.36

BCBS / Anthem

$0.25

UnitedHealthcare

$0.33

Aetna

$0.49

Cigna

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HCPCS J1815

5 of 25 sample ratesHigher to lower in this preview

Sutter Bay Hospitals, California Pacific Medical Center
Sutter Bay Hospitals
CAGeneral Acute Care HospitalNPI 1740348929Tax ID 94-0562680
$2.60Published rate
St Johns Hospital Of The Hospital Sisters Of The Third Order Of St F, Medicar Part B Billing Under Arrangement On Physician Interpretations
St Johns Hospital Of The Hospital Sisters Of The Third Order Of St F
ILGeneral Acute Care HospitalNPI 1184606923Tax ID 37-0661238
$0.23Published rate
Hospital Service District 1 Of East Baton Rouge Parish
LAGeneral Acute Care HospitalNPI 1790057933Tax ID 72-6015227
$0.21Published rate
Jackson County Memorial Hospital Authority, Jackson Co Mem Hosp
OKGeneral Acute Care HospitalNPI 1093763781Tax ID 73-0568956
$0.21Published rate
Jennifer Drouet
New York City Health And Hospitals Corporation
NYGeneral Acute Care HospitalNPI 1073975942Tax ID 13-2655001
$0.17Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

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HCPCS J1815 vs. Other Drugs, Administered by Injection Codes

The table lists codes related to J1815. Select one to see its fee schedule.

Code	Description
00002751101-NDC	Humalog Mix75/25 (Insulin lispro) 100 [iU]/mL, injection, suspension
00002751199-NDC	Humalog Mix75/25 (Insulin lispro) 100 [iU]/mL, injection, suspension
00002751201-NDC	Humalog Mix50/50 (Insulin lispro) 100 [iU]/mL, injection, suspension
J1815-HCPCS	Injection, insulin, per 5 units

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J1815. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the J1815 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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Frequently Asked Questions

How does Medicare pay for HCPCS J1815 in an ambulatory surgery center?

CMS lists HCPCS J1815 with ASC payment indicator N1: Packaged; no separate payment.

Which revenue codes are billed with HCPCS J1815?

Hospital price transparency files list HCPCS J1815 under these revenue codes: 0636, 0250, 0637 and 0259. A revenue code names the hospital department or charge category for the line; it does not change what the service is.