HCPCS J8498 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 • Drugs, Not Otherwise Classified |
| Common Place of Service | • None • 50 - Federally Qualified Health Center • 11 - Office |
| Complexity Level | Low |
| Related NDC Codes | • 00574-7226-12 - COMPRO 25 MG • 00713-0135-12 - PROCHLORPERAZINE 25 MG • 00713-0526-12 - PROMETHEGAN 25 MG • 00713-0536-12 - PROMETHEGAN 12.5 MG • 31722-0040-31 - PROMETHAZINE HCL (USP) 12.5 MG |
National average reimbursement for HCPCS J8498 by major payers:
$54.80
$39.93
$49.42
$10.99
| 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 J8498 | ||||||
United | J8498 | $64.00 | 1295163244 - MONTEFIORE NEW ROCHELLE HOSPITAL, MONTEFIORE NEW ROCHELLE PROFESSIONAL BILLING | 462931956 - (NY) MONTEFIORE NEW ROCHELLE HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | J8498 | $64.00 | 1295163244 - MONTEFIORE NEW ROCHELLE HOSPITAL, MONTEFIORE NEW ROCHELLE PROFESSIONAL BILLING | 462931956 - (NY) MONTEFIORE NEW ROCHELLE HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | J8498 | $64.00 | 1013345065 - MONTEFIORE MOUNT VERNON HOSPITAL, MONTEFIORE MOUNT VERNON PROFESSIONAL BILLING | 462916938 - (NY) MONTEFIORE MOUNT VERNON HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | J8498 | $64.00 | 1013345065 - MONTEFIORE MOUNT VERNON HOSPITAL, MONTEFIORE MOUNT VERNON PROFESSIONAL BILLING | 462916938 - (NY) MONTEFIORE MOUNT VERNON HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | J8498 | $64.00 | 1922079094 - SOUTH NASSAU COMMUNITIES HOSPITAL | 111352310 - (NY) SOUTH NASSAU COMMUNITIES HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | J8498 | $64.00 | 1922079094 - SOUTH NASSAU COMMUNITIES HOSPITAL | 111352310 - (NY) SOUTH NASSAU COMMUNITIES HOSPITAL | NY | 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 J8498 vs. Other Drugs, Not Otherwise Classified Codes
The HCPCS J8498 code is part of the Drugs Administered Other than Oral Method services used for Drugs, Not Otherwise Classified. 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 J8498 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 |
|---|---|---|
| 00574-7226-12-NDC | Moderate | COMPRO 25 MG |
| 00713-0135-12-NDC | Moderate | PROCHLORPERAZINE 25 MG |
| 00713-0526-12-NDC | Moderate | PROMETHEGAN 25 MG |
| J8498-HCPCS | Low | Antiemetic drug, rectal/suppository, not otherwise specified |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J8498. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J8498 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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