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See a sample rate comparisonHCPCS J7516 (Sandimmune) Fee Schedule
Last Verified: October 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, cyclosporine, 250 mg
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Immunosuppressive Drugs |
| Common Place of Service | None 11 - Office 99 - Other POS |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for J7516 |
| Medicare Payment Limit | $72.581  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
| Related NDC Codes | • 00078-0109-01 - SANDIMMUNE (AMP) 50 MG/ML • 38779-0660-03 - CYCLOSPORIN A • 38779-0660-04 - CYCLOSPORIN A • 38779-0660-05 - CYCLOSPORIN A • 38779-0660-06 - CYCLOSPORIN A |
National average reimbursement for HCPCS J7516 by major payers:
$58.05
$69.54
$68.81
$65.71
Compare published rates across providers.
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HCPCS J7516
5 of 25 sample ratesHigher to lower in this preview
Stafford Hospital, LLC, Stafford Hospital
Stafford Hospital LLC
$134.88Published rateNew York University Langone Medical Center
New York University
$75.63Published rateLakeland Regional Medical Center, Inc., Lakeland Regional Medical Center
Lakeland Regional Health Systems Inc
$71.36Published rateMississippi Baptist Medical Center, Inc
Mississippi Baptist Medical Center
$68.41Published rateUniversity Hospital At Stony Brook, Stony Brook Southampton Hospital
$27.60Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS J7516 vs. Other Immunosuppressive Drugs Codes
The HCPCS J7516 code is part of the Drugs Administered Other than Oral Method services used for Immunosuppressive 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 J7516 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 |
|---|---|---|
| 00078-0109-01-NDC | Moderate | SANDIMMUNE (AMP) 50 MG/ML |
| 38779-0660-03-NDC | Moderate | CYCLOSPORIN A |
| 38779-0660-04-NDC | Moderate | CYCLOSPORIN A |
| J7516-HCPCS | Low | Injection, cyclosporine, 250 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J7516. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J7516 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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