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See a sample rate comparisonHCPCS J8530 (Cyclophosphamide) 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.
Cyclophosphamide; oral, 25 mg
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Chemotherapy Drugs, Oral and IV Administration |
| Common Place of Service | None 11 - Office |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for J8530 |
| Medicare Payment Limit | $1.097  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J8530 by major payers:
$1.03
$1.26
$1.34
$1.02
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HCPCS J8530
5 of 25 sample ratesHigher to lower in this preview
Hudson Valley Hospital Center
$7.42Published rateThe Queen'S Medical Center
The Queens Medical Center
$1.25Published rateJason Mckean
North Shore-Lij Medical PC
$1.00Published rateSinai Hospital
Sinai Hospital Of Baltimore Inc
$0.86Published rateSteven Lewis
Kauai Medical Clinic
$0.74Published rate
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See a sample payer proposalHCPCS J8530 vs. Other Chemotherapy Drugs, Oral and IV Administration Codes
The HCPCS J8530 code is part of the Drugs Administered Other than Oral Method services used for Chemotherapy Drugs, Oral and IV Administration. 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 J8530 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 |
|---|---|---|
| J8530-HCPCS | Low | Cyclophosphamide; oral, 25 mg |
| J8540-HCPCS | Low | Dexamethasone, oral, 0.25 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J8530. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J8530 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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