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See a sample rate comparisonHCPCS J1815 (Apidra) 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, insulin, per 5 units
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Drugs, Administered by Injection |
| Common Place of Service | None 11 - Office |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for J1815 |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
| Related NDC Codes | • 00002-7511-01 - HUMALOG MIX 75/25 (VIAL) 75 U/ML-25 U/ML • 00002-7511-99 - HUMALOG MIX 75/25 (VIAL) 75 U/1 ML-25 U/1 ML • 00002-7512-01 - HUMALOG MIX 50/50 50 U/ML-50 U/ML • 00002-7512-99 - HUMALOG MIX 50/50 50 U/1 ML-50 U/1 ML • 00002-7516-59 - HUMALOG (CARTRIDGE) 100 U/ML |
National average reimbursement for HCPCS J1815 by major payers:
$0.36
$0.25
$0.33
$0.49
Compare published rates across providers.
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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
$2.60Published rateSt 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
$0.23Published rateHospital Service District 1 Of East Baton Rouge Parish
$0.21Published rateJackson County Memorial Hospital Authority, Jackson Co Mem Hosp
$0.21Published rateJennifer Drouet
New York City Health And Hospitals Corporation
$0.17Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS J1815 vs. Other Drugs, Administered by Injection Codes
The HCPCS J1815 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 J1815 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 |
|---|---|---|
| 00002-7511-01-NDC | Moderate | HUMALOG MIX 75/25 (VIAL) 75 U/ML-25 U/ML |
| 00002-7511-99-NDC | Moderate | HUMALOG MIX 75/25 (VIAL) 75 U/1 ML-25 U/1 ML |
| 00002-7512-01-NDC | Moderate | HUMALOG MIX 50/50 50 U/ML-50 U/ML |
| J1815-HCPCS | Low | 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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