HCPCS J9056 (Vivimusta) 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 • 10 - Telehealth in Patient's Home |
| Complexity Level | Low |
| Medicare Payment Limit | $29.852  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J9056 by major payers:
$30.21
$30.16
$31.01
$29.63
| 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 J9056 | ||||||
United | J9056 | $39.25 | 1811230873 - PETER DEMARIA | 752131429 - US ONCOLOGY CORPORATE, INC. | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9056 | $38.15 | 1568776391 - JOHN MATHEWS | 752131429 - US ONCOLOGY CORPORATE, INC. | TX | Medical Oncology Physician (207RX0202X) |
United | J9056 | $32.95 | 1932140159 - ERIC KLEINBAUM | 824681345 | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9056 | $38.27 | 1447541594 - DEEPNA JAISWAL | 752512142 - (TX) ONCOLOGY-HEMATOLOGY CONSULTANTS, P.A. | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9056 | $40.04 | 1366549735 - NEELIMA MADDUKURI | 752131429 - US ONCOLOGY CORPORATE, INC. | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9056 | $38.38 | 1528332970 - LINCOLN MEDICAL AND MENTAL HEALTH CENTER | 132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | NY | General Acute Care Hospital (282N00000X) |
United | J9056 | $34.38 | 1730164591 - BRIAN SHIMKUS | 460829574 - (TX) CENTRAL TEXAS MEDICAL SPECIALISTS, PLLC, D/B/A AUSTIN CANCER CENTERS | TX | Medical Oncology Physician (207RX0202X) |
United | J9056 | $40.04 | 1619266533 - ELIZABETH POLLARD | 752131429 - US ONCOLOGY CORPORATE, INC. | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9056 | $38.99 | 1578597324 - NABEEL SHALAN | 300520570 - (TX) METHODIST HOSPITAL | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9056 | $55.88 | 1063874758 - CHAD GUENTHER | 956419205 - (CA) SANSUM CLINIC | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9056 | $28.64 | 1780631911 - JOHN LOHREY | 756002868 | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9056 | $38.15 | 1902255276 - MICHAEL LATTANZI | 752131429 - US ONCOLOGY CORPORATE, INC. | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9056 | $34.38 | 1487818811 - ANGEL RODRIGUEZ | 460829574 - (TX) CENTRAL TEXAS MEDICAL SPECIALISTS, PLLC, D/B/A AUSTIN CANCER CENTERS | TX | Medical Oncology Physician (207RX0202X) |
United | J9056 | $31.45 | 1023011491 - TYLER HEMATOLOGY ONCOLOGY, P.A. | 752288596 - (TX) TYLER HEMATOLOGY ONCOLOGY, PA | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9056 | $31.88 | 1265426282 - MURALIDHAR BEERAM | 742915297 - (TX) SOUTH TEXAS ONCOLOGY & HEMATOLOGY, PLLC | TX | Medical Oncology Physician (207RX0202X) |
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 J9056 vs. Other Chemotherapy Drugs Codes
The HCPCS J9056 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 J9056 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 |
|---|---|---|
| J9055-HCPCS | Low | Injection, cetuximab, 10 mg |
| J9056-HCPCS | Low | Injection, bendamustine hydrochloride (vivimusta), 1 mg |
| J9057-HCPCS | Low | Injection, copanlisib, 1 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J9056. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J9056 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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