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See a sample rate comparisonHCPCS J3263 (Loqtorzi) 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, toripalimab-tpzi, 1 mg
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Drugs, Administered by Injection |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for J3263 |
| Medicare Payment Limit | $39.409  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J3263 by major payers:
$41.22
$39.36
$77.01
$46.58
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HCPCS J3263
5 of 25 sample ratesHigher to lower in this preview
Christina Boyd
$157.94Published rateAdventist Midwest Health, Uchicago Medicine Adventhealth Hinsdale
Adventist Midwest Health
$43.77Published rateSt Josephs Hospital Breese Of The Hospital Sisters Of The Third Orde, St. Joseph'S Hospital
St Josephs Hosp Of The Hosp Sisters Of The 3rd Order Of St Francis
$41.24Published rateOsf Healthcare System, Osf Little Company Of Mary Medical Center
Osf Healthcare System
$39.25Published rateNew York City Health And Hospitals Corporation, Metropolitan Hospital Center
New York City Health And Hospitals Corporation
$30.82Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS J3263 vs. Other Drugs, Administered by Injection Codes
The HCPCS J3263 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 J3263 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 |
|---|---|---|
| J3263-HCPCS | Low | Injection, toripalimab-tpzi, 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 J3263. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J3263 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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