HCPCS J7309 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Drugs Administered Other than Oral Method • Miscellaneous Drugs |
| Common Place of Service | • 11 - Office • None • 50 - Federally Qualified Health Center |
| Complexity Level | Low |
National average reimbursement for HCPCS J7309 by major payers:
$52.97
$96.08
$79.77
$88.10
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS J7309 | ||||||
United | J7309 | $591.42 | 1396882205 - VANDERBILT UNIVERSITY MEDICAL CENTER | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | General Acute Care Hospital (282N00000X) |
United | J7309 | $71.13 | 1548750417 - UKHS GREAT BEND, LLC, THE UNIVERSITY OF KANSAS HEALTH SYSTEM GREAT BEND CAMPUS | 830516935 | KS | General Acute Care Hospital (282N00000X) |
United | J7309 | $94.73 | 1285891960 - LUNG AND CHEST MEDICAL ASSOCIATES | 570916738 | SC | General Acute Care Hospital (282N00000X) |
United | J7309 | $95.69 | 1043260482 - SAINT FRANCIS MEDICAL CENTER, OSF SAINT FRANCIS MEDICAL CENTER | 383852646 - OSF MULTI-SPECIALTY GROUP | IL | General Acute Care Hospital (282N00000X) |
United | J7309 | $94.73 | 1851336044 - ST. JOSEPHS COMMUNITY HOSPITAL OF WEST BEND INC., FROEDTERT WEST BEND HOSPITAL | 390806302 - (WI) ST JOSEPHS COMMUNITY HOSPITAL OF WEST BEND INC | WI | General Acute Care Hospital (282N00000X) |
United | J7309 | $94.73 | 1356860621 - CHI MEMORIAL HOSPITAL | 822748395 - CHI MEMORIAL HOSPITAL - GEORGIA | GA | General Acute Care Hospital (282N00000X) |
United | J7309 | $94.73 | 1205865789 - SOUTHWESTERN VERMONT MEDICAL CENTER INC. | 222563241 - SOUTHWESTERN VERMONT MEDICAL CENTER INC | VT | General Acute Care Hospital (282N00000X) |
United | J7309 | $168.03 | 1255785069 - ROSALYN GAMBOA | 133278552 - (NY) MEMORIAL CARDIOPULMONARY GROUP | NY | General Acute Care Hospital (282N00000X) |
United | J7309 | $94.73 | 1942485321 - SUMMIT GUPTA | 270759755 | MD | General Acute Care Hospital (282N00000X) |
United | J7309 | $100.51 | 1629057302 - ST ELIZABETHS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER, HSHS ST. ELIZABETH'S HOSPITAL | 370663567 - (IL) ST ELIZABETHS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDE | IL | General Acute Care Hospital (282N00000X) |
United | J7309 | $94.73 | 1750388963 - DULCE HEALTH CENTER, JICARILLA SERVICE UNIT | 850434685 - (NM) DULCE HEALTH CENTER | NM | General Acute Care Hospital (282N00000X) |
United | J7309 | $104.20 | 1881804458 - AVERA MCKENNAN, AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTER - PLACEMENT | 460224743 - AVERA MCKENNAN | SD | General Acute Care Hospital (282N00000X) |
United | J7309 | $113.69 | 1497099063 - FARAH PIRACHA | 453023019 - (NY) NORTH SHORE-LIJ MEDICAL PC | NY | General Acute Care Hospital (282N00000X) |
United | J7309 | $100.41 | 1366947210 - JASON RAGGI | 274181529 - (NY) HARLEM MEDICAL ASSOCIATES PC | NY | General Acute Care Hospital (282N00000X) |
United | J7309 | $104.20 | 1114473212 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH CANCER INST-FARIS | 571004971 - PRISMA HEALTH-UNIVERSITY MEDICAL GROUP | SC | General Acute Care Hospital (282N00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS J7309 vs. Other Miscellaneous Drugs Codes
The HCPCS J7309 code is part of the Drugs Administered Other than Oral Method services used for Miscellaneous Drugs. 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 J7309 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 |
|---|---|---|
| J7308-HCPCS | Moderate | Aminolevulinic acid HCl for topical administration, 20%, single unit dosage form (354 mg) |
| J7309-HCPCS | Low | Methyl aminolevulinate (MAL) for topical administration, 16.8%, 1 gram |
| J7310-HCPCS | High | Ganciclovir, 4.5 mg, long-acting implant |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J7309. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J7309 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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