HCPCS J9055 (Erbitux) 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 | • Chemotherapy Drugs |
| Common Place of Service | • None • 11 - Office • 22 - On Campus Outpatient Hospital |
| Complexity Level | Low |
| Medicare Payment Limit | $78.369  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
| Related NDC Codes | • 66733-0948-23 - ERBITUX (PF) 2 MG/ML • 66733-0958-23 - ERBITUX (PF) 2 MG/ML |
National average reimbursement for HCPCS J9055 by major payers:
$83.67
$81.22
$83.24
$80.14
| 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 J9055 | ||||||
United | J9055 | $103.30 | 1376929489 - NADEZHDA IBRAGIMOVA | 61578286 - DOWNTOWN BRONX MEDICAL ASSOCIATES PC | NY | General Acute Care Hospital (282N00000X) |
United | J9055 | $139.77 | 1356309322 - HEALTHEAST WOODWINDS HOSPITAL, M HEALTH FAIRVIEW WOODWINDS HOSPITAL | 411592761 - (MN) HEALTHEAST WOODWINDS HOSPITAL | MN | General Acute Care Hospital (282N00000X) |
United | J9055 | $77.09 | 1285613836 - SANTA FE INDIAN HOSPITAL | 850434679 | NM | General Acute Care Hospital (282N00000X) |
United | J9055 | $164.22 | 1013233600 - FLORIAN RIEDER | 340714585 - THE CLEVELAND CLINIC FOUNDATION | OH | General Acute Care Hospital (282N00000X) |
United | J9055 | $85.83 | 1164481677 - PARMA COMMUNITY GENERAL HOSPITAL ASSOCIATION, UNIVERSITY HOSPITALS PARMA MEDICAL CENTER | 340827442 - (OH) UNIVERSITY HOSPITALS HEALTH SYSTEM INC | OH | General Acute Care Hospital (282N00000X) |
United | J9055 | $96.48 | 1679663835 - CAROLE DUBUCHE | 134118387 - BRIGHTPOINT HEALTH | NY | General Acute Care Hospital (282N00000X) |
United | J9055 | $75.43 | 1881697043 - HAYS MEDICAL CENTER INC | 480559088 - (KS) HAYS MEDICAL CENTER INC | KS | General Acute Care Hospital (282N00000X) |
United | J9055 | $95.48 | 1538112230 - ASPIRUS STEVENS POINT HOSPITAL & CLINICS, INC., ASPIRUS STEVENS POINT HOSPITAL & CLINICS, INC. | 390807065 - ASPIRUS STANLEY HOSPITAL & CLINICS INC | WI | General Acute Care Hospital (282N00000X) |
United | J9055 | $77.09 | 1033218128 - THE UNIVERSITY OF CHICAGO MEDICAL CENTER | 363488183 - UNIVERSITY OF CHICAGO MEDICAL CENTER | IL | General Acute Care Hospital (282N00000X) |
United | J9055 | $81.73 | 1346250594 - PROVIDENCE HEALTH & SERVICES WASHINGTON, PROVIDENCE ST PETER HOSPITAL | 910567732 | WA | General Acute Care Hospital (282N00000X) |
United | J9055 | $75.43 | 1629026364 - ADVOCATE SHERMAN HOSPITAL, SHERMAN FAMILY HEALTHCARE | 362167920 - (IL) ADVOCATE SHERMAN HOSPITAL | IL | General Acute Care Hospital (282N00000X) |
United | J9055 | $103.30 | 1760421713 - THE UNITY HOSPITAL OF ROCHESTER, PARK RIDGE HOSPITAL | 237221763 - THE UNITY HOSPITAL OF ROCHESTER | NY | General Acute Care Hospital (282N00000X) |
United | J9055 | $75.62 | 1699768705 - GONZALES HEALTHCARE SYSTEMS | 741625013 | TX | General Acute Care Hospital (282N00000X) |
United | J9055 | $96.48 | 1508941097 - ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM, CHI HEALTH CREIGHTON UNIVERSITY MEDICAL CENTER-BERGAN MERCY | 470757164 - ALEGENT CREIGHTON HEALTH | NE | General Acute Care Hospital (282N00000X) |
United | J9055 | $84.19 | 1457319154 - ST JOSEPHS HOSPITAL BREESE OF THE HOSPITAL SISTERS OF THE THIRD ORDE, ST. JOSEPH'S HOSPITAL | 371208459 - (IL) ST JOSEPHS HOSP OF THE HOSP SISTERS OF THE 3RD ORDER OF ST FRANCIS | IL | 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 J9055 vs. Other Chemotherapy Drugs Codes
The HCPCS J9055 code is part of the Chemotherapy Drugs services . 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 J9055 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 |
|---|---|---|
| 66733-0948-23-NDC | Moderate | ERBITUX (PF) 2 MG/ML |
| 66733-0958-23-NDC | Moderate | ERBITUX (PF) 2 MG/ML |
| J9050-HCPCS | Moderate | Injection, carmustine, 100 mg |
| J9055-HCPCS | Low | Injection, cetuximab, 10 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J9055. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J9055 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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