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See a sample rate comparisonHCPCS J2426 (Invega Sustenna) 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, paliperidone palmitate extended release (invega sustenna), 1 mg
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Drugs, Administered by Injection |
| Common Place of Service | 11 - Office None 50 - Federally Qualified Health Center |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for J2426 |
| Medicare Payment Limit | $15.111  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J2426 by major payers:
$15.19
$15.15
$15.85
$15.62
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HCPCS J2426
5 of 25 sample ratesHigher to lower in this preview
UPMC Altoona, Altoona Family Physicians
UPMC
$24.62Published 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
$15.65Published rateTraverse Anesthesia Associates
Traverse Anesthesia Associates, PC
$14.76Published rateHalifax Hospital Medical Center, Halifax Medical Center
$14.72Published rateGainesville Community Hospital, Inc., North Texas Medical Center
Gainesville Community Hospital Inc
$14.65Published rate
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See a sample payer proposalHCPCS J2426 vs. Other Drugs, Administered by Injection Codes
The HCPCS J2426 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 J2426 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 |
|---|---|---|
| J2425-HCPCS | Low | Injection, palifermin, 50 micrograms |
| J2426-HCPCS | Low | Injection, paliperidone palmitate extended release (invega sustenna), 1 mg |
| J2427-HCPCS | Low | Injection, paliperidone palmitate extended release (invega hafyera, or invega trinza), 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 J2426. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J2426 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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