HCPCS J9248 (Hepzato) 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 |
| Complexity Level | Moderate |
| Medicare Payment Limit | $795  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J9248 by major payers:
$800.83
$1,317.13
$1,516.81
$920.88
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | J9248 | $837.02 | 1801074455 - BHAVNA GUPTA | 271378855 | NJ | Medical Oncology Physician (207RX0202X) |
United | J9248 | $944.03 | 1801826912 - WELLMONT HEALTH SYSTEM, LONESOME PINE HOSPITAL | 621636465 - WELLMONT HEALTH SYSTEM | VA | General Acute Care Hospital (282N00000X) |
United | J9248 | $744.59 | 1619039260 - JENIA JENAB-WOLCOTT | 510064318 | NJ | Hematology & Oncology Physician (207RH0003X) |
United | J9248 | $861.40 | 1083710842 - WILLIAM KESSLER | 1083710842 | NJ | Medical Oncology Physician (207RX0202X) |
United | J9248 | $773.79 | 1437158433 - EXETER HOSPITAL INC | 222674014 - (NH) EXETER HOSPITAL INC | NH | General Acute Care Hospital (282N00000X) |
United | J9248 | $858.91 | 1871595348 - DEBORAH BUTZBACH | 232865181 | NJ | Radiation Oncology Physician (2085R0001X) |
United | J9248 | $817.59 | 1578872776 - STEPHAN DORKHOM | 222810004 | NJ | Hematology & Oncology Physician (207RH0003X) |
United | J9248 | $773.79 | 1124472972 - DANNY MARKABAWI | 223310529 | NJ | Hematology & Oncology Physician (207RH0003X) |
United | J9248 | $751.90 | 1356876791 - ALISON GREIDINGER | 223266219 | NJ | Hematology & Oncology Physician (207RH0003X) |
United | J9248 | $497.01 | 1407219181 - SARAH ALLEN | 132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | CA | General Acute Care Hospital (282N00000X) |
United | J9248 | $698.96 | 1386645695 - LAWRENCE TENA | 461243081 | NJ | Radiation Oncology Physician (2085R0001X) |
United | J9248 | $1354.15 | 1598719346 - CLEVELAND CLINIC HEALTH SYSTEM, EUCLID HOSPITAL | 340714593 - CLEVELAND CLINIC HEALTH SYSTEM EAST REGION | OH | General Acute Care Hospital (282N00000X) |
United | J9248 | $841.11 | 1548286339 - ANDREW GREENBERG | 20543270 | NJ | Radiation Oncology Physician (2085R0001X) |
United | J9248 | $744.59 | 1295701217 - UNICOI COUNTY MEMORIAL HOSPITAL INC, UNICOI CTY MEMORIAL HOSPITAL CTY NURSING HOME CTY HOME HEALTH AGENCY | 581837116 - (TN) UCMH HEALTH INC | TN | General Acute Care Hospital (282N00000X) |
United | J9248 | $797.01 | 1679695928 - MILA GORSKY | 593801080 | NJ | Hematology & Oncology Physician (207RH0003X) |
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 J9248 vs. Other Chemotherapy Drugs Codes
The HCPCS J9248 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 J9248 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 |
|---|---|---|
| J9248-HCPCS | Moderate | Injection, melphalan (hepzato), 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 J9248. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J9248 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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