HCPCS J9223 (Zepzelca) 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 • 19 - Off Campus Outpatient Hospital |
| Complexity Level | Moderate |
| Medicare Payment Limit | $207.127  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J9223 by major payers:
$217.35
$218.22
$220.64
$215.63
| 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 J9223 | ||||||
United | J9223 | $202.75 | 1699754812 - HARDIN COUNTY GENERAL HOSPITAL, HARDIN MEDICAL CENTER | 626002428 - (TN) HARDIN COUNTY GENERAL HOSPITAL | TN | General Acute Care Hospital (282N00000X) |
United | J9223 | $203.60 | 1225450588 - PARISH HOSPITAL SERVICE DISTRICT FOR THE PARISH OF ORLEANS, NEW ORLEANS EAST HOSPITAL | 273335876 | LA | General Acute Care Hospital (282N00000X) |
United | J9223 | $232.10 | 1699769901 - CURATORS OF THE UNIVERSITY OF MISSOURI, UNIVERSITY OF MISSOURI HEALTH CARE | 900294051 | MO | General Acute Care Hospital (282N00000X) |
United | J9223 | $215.82 | 1992755292 - GENEVA COUNTY HEALTHCARE AUTHORITY, INC., WIREGRASS MEDICAL CENTER | 636004474 - (AL) GENEVA COUNTY HEALTH CARE AUTHORITY INC DBA WIREGRASS MEDICAL CENTER | AL | General Acute Care Hospital (282N00000X) |
United | J9223 | $192.72 | 1134194038 - CHRISTIANA CARE HEALTH SERVICES, INC., CHRISTIANA CARE | 510103684 - CHRISTIANA CARE HEALTH SERVICES INC | DE | General Acute Care Hospital (282N00000X) |
United | J9223 | $202.75 | 1487218509 - SMSJ TUCSON HOLDINGS, LLC, CARONDELET MARANA HOSPITAL | 474131755 | AZ | General Acute Care Hospital (282N00000X) |
United | J9223 | $199.52 | 1669431219 - SHORE HEALTH SYSTEM, INC, UM SHORE MEDICAL CENTER AT EASTON | 520610538 - (MD) SHORE HEALTH SYSTEM INC | MD | General Acute Care Hospital (282N00000X) |
United | J9223 | $334.54 | 1992799050 - GRADY MEMORIAL HOSPITAL CORPORATION, GRADY HEALTH SYSTEMS | 262037695 - GRADY MEMORIAL HOSPITAL CORPORATION | GA | General Acute Care Hospital (282N00000X) |
United | J9223 | $259.23 | 1356391247 - ASPIRUS RHINELANDER & TOMAHAWK HOSPITALS & CLINICS, INC., ASPIRUS RHINELANDER & TOMAHAWK HOSPITALS & CLINICS, INC. | 391390638 - ASPIRUS RHINELANDER & TOMAHAWK HOSPITALS & CLINICS INC | WI | General Acute Care Hospital (282N00000X) |
United | J9223 | $203.60 | 1306184916 - MARYAMNAZ FALAMAKI | 760010407 | NY | General Acute Care Hospital (282N00000X) |
United | J9223 | $202.75 | 1194751958 - TAOS HEALTH SYSTEMS INC HOLY CROSS HOSPITAL, HOLY CROSS HOSPITAL | 850289839 - (NM) TAOS HEALTH SYSTEMS INC HOLY CROSS HOSPITAL | NM | General Acute Care Hospital (282N00000X) |
United | J9223 | $204.89 | 1245274901 - ST. AGNES HEALTHCARE, INC., ST.AGNES HOSPITAL | 520591657 - ST AGNES HEALTHCARE INC | MD | General Acute Care Hospital (282N00000X) |
United | J9223 | $203.60 | 1255302766 - BULLHEAD CITY HOSPITAL CORPORATION, WESTERN ARIZONA REGIONAL MEDICAL CENTER | 860982071 - (AZ) BULLHEAD CITY HOSPITAL CORPORATION | AZ | General Acute Care Hospital (282N00000X) |
United | J9223 | $272.82 | 1306930318 - IRA DAVENPORT MEMORIAL HOSPITAL, INC. | 160835446 - (NY) IRA DAVENPORT MEMORIAL HOSPITAL INC | NY | General Acute Care Hospital (282N00000X) |
United | J9223 | $435.92 | 1568442309 - THE COOPER HEALTH SYSTEM | 210634462 - (NJ) COOPER HEALTH SYSTEM A NEW JERSEY NON-PROFIT CORPORATION | NJ | 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 J9223 vs. Other Chemotherapy Drugs Codes
The HCPCS J9223 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 J9223 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 |
|---|---|---|
| J9219-HCPCS | High | Leuprolide acetate implant, 65 mg |
| J9223-HCPCS | Moderate | Injection, lurbinectedin, 0.1 mg |
| J9225-HCPCS | High | Histrelin implant (Vantas), 50 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J9223. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J9223 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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