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See a sample rate comparisonHCPCS J8499 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.
Prescription drug, oral, non chemotherapeutic, NOS
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Drugs, Not Otherwise Classified |
| Common Place of Service | None 11 - Office 20 - Urgent Care Facility |
| Complexity Level | Low |
| Related NDC Codes | • 00004-0038-22 - VALCYTE 450 MG • 00378-0253-01 - ACYCLOVIR 400 MG • 00378-8712-73 - ACYCLOVIR (BANANA) 200 MG/5 ML • 00378-9735-73 - ZOVIRAX 200 MG/5 ML • 00472-0082-16 - ACYCLOVIR 200 MG/5 ML |
National average reimbursement for HCPCS J8499 by major payers:
$1.40
$47.50
$1.09
$42.79
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HCPCS J8499
5 of 25 sample ratesHigher to lower in this preview
Montefiore New Rochelle Hospital, Montefiore New Rochelle Professional Billing
Montefiore New Rochelle Hospital
$64.00Published rateNorth Shore Medical Center, Inc., North Shore Medical Center
$60.00Published rateVariety Children'S Hospital, Nicklaus Children'S Hospital
Variety Childrens Hospital
$55.00Published rateVariety Children'S Hospital, Nicklaus Children'S Miami Lakes Outpatient Center
Variety Childrens Hospital
$40.00Published rateTenet Healthsystem Memorial Medical Center, Inc., Memorial Medical Center
$7.51Published rate
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See a sample payer proposalHCPCS J8499 vs. Other Drugs, Not Otherwise Classified Codes
The HCPCS J8499 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 J8499 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 |
|---|---|---|
| 00004-0038-22-NDC | Moderate | VALCYTE 450 MG |
| 00378-0253-01-NDC | Moderate | ACYCLOVIR 400 MG |
| 00378-8712-73-NDC | Moderate | ACYCLOVIR (BANANA) 200 MG/5 ML |
| J8499-HCPCS | Low | Prescription drug, oral, non chemotherapeutic, NOS |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J8499. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J8499 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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