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See a sample rate comparisonHCPCS J9204 (Poteligeo) 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, mogamulizumab-kpkc, 1 mg
| Key Fact | Detail |
|---|---|
| Service Type | Chemotherapy Drugs |
| Common Place of Service | None 11 - Office 20 - Urgent Care Facility |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for J9204 |
| Medicare Payment Limit | $248.497  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
| Related NDC Codes | • 42747-0761-01 - POTELIGEO (PF) 4 MG/1 ML |
National average reimbursement for HCPCS J9204 by major payers:
$235.75
$255.69
$257.80
$252.96
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HCPCS J9204
5 of 25 sample ratesHigher to lower in this preview
Cassandra Thomas
$332.00Published rateRobert Tassan
$262.73Published rateBellevue Medical Center LLC, Bellevue Medical Center - Nebraska Medicine
Bellevue Medical Center LLC
$252.83Published rateUmdnj
$243.32Published rateRajesh Nahar
$214.97Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS J9204 vs. Other Chemotherapy Drugs Codes
The HCPCS J9204 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 J9204 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 |
|---|---|---|
| 42747-0761-01-NDC | Moderate | POTELIGEO (PF) 4 MG/1 ML |
| J9203-HCPCS | Moderate | Injection, gemtuzumab ozogamicin, 0.1 mg |
| J9204-HCPCS | Moderate | Injection, mogamulizumab-kpkc, 1 mg |
| J9205-HCPCS | Low | Injection, irinotecan liposome, 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 J9204. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J9204 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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