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See a sample rate comparisonHCPCS J3486 (Geodon) 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, ziprasidone mesylate, 10 mg
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Drugs, Administered by Injection |
| Common Place of Service | None 20 - Urgent Care Facility 23 - Emergency Room 11 - Office 22 - On Campus Outpatient Hospital |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for J3486 |
| Medicare Payment Limit | $6.826  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
| Related NDC Codes | • 00049-3920-10 - GEODON (LYOPHILIZED) 20 MG • 00049-3920-83 - GEODON 20 MG • 43598-0848-58 - ZIPRASIDONE MESYLATE (LYOPHILIZED) 20 MG • 58151-0137-81 - GEODON LYOPHILIZED 20 MG • 72205-0205-07 - ZIPRASIDONE MESYLATE (SDV,PF,LATEX-FREE) 20 MG |
National average reimbursement for HCPCS J3486 by major payers:
$8.42
$8.97
$9.56
$8.32
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HCPCS J3486
5 of 25 sample ratesHigher to lower in this preview
Mills-Peninsula Health Services, Peninsula Hospital And Mills Hospital
Sutter Bay Hospitals
$50.99Published rateFalmouth Hospital Association Inc
Cape Cod Healthcare Inc
$10.78Published rateSuhaib Andrabi
Harlem Medical Associates PC
$7.61Published rateTrinity Regional Medical Center, Unitypoint Health Trinity Regional Medical Center
Unity Healthcare
$7.42Published rateErnest Kirchman
New York City Health And Hospitals Corporation
$4.75Published rate
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See a sample payer proposalHCPCS J3486 vs. Other Drugs, Administered by Injection Codes
The HCPCS J3486 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 J3486 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 |
|---|---|---|
| 00049-3920-10-NDC | Moderate | GEODON (LYOPHILIZED) 20 MG |
| 00049-3920-83-NDC | Moderate | GEODON 20 MG |
| 43598-0848-58-NDC | Moderate | ZIPRASIDONE MESYLATE (LYOPHILIZED) 20 MG |
| J3486-HCPCS | Low | Injection, ziprasidone mesylate, 10 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J3486. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J3486 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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