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See a sample rate comparisonHCPCS J9198 (Infugem) 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.
Injection, gemcitabine hydrochloride, (infugem), 100 mg
| Key Fact | Detail |
|---|---|
| Service Type | Chemotherapy Drugs |
| Common Place of Service | None 24 - Ambulatory Surgical Center 11 - Office |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for J9198 |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J9198 by major payers:
$37.78
$40.79
$41.24
$41.32
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HCPCS J9198
5 of 25 sample ratesHigher to lower in this preview
Gregory Alexander
$51.29Published rateVijay Roy
$42.29Published rateBurke Hospital Company, Burke Health
Burke Hospital Company, LLC
$40.27Published rateDesoto Hospital Association, Desoto Regional Health System
Desoto Hospital Association
$36.86Published rateChristina Ciraco
New York City Health And Hospitals Corporation
$25.12Published rate
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See a sample payer proposalHCPCS J9198 vs. Other Chemotherapy Drugs Codes
The HCPCS J9198 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 J9198 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 |
|---|---|---|
| J9196-HCPCS | Low | Injection, gemcitabine hydrochloride (accord), not therapeutically equivalent to j9201, 200 mg |
| J9198-HCPCS | Low | Injection, gemcitabine hydrochloride, (infugem), 100 mg |
| J9200-HCPCS | High | Injection, floxuridine, 500 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J9198. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J9198 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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