HCPCS J9250 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 | • 11 - Office • None • 22 - On Campus Outpatient Hospital |
| Complexity Level | Low |
National average reimbursement for HCPCS J9250 by major payers:
$0.27
$0.57
$N/A
$0.34
| 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 J9250 | ||||||
United | J9250 | $0.31 | 1255376828 - THE BIBB COUNTY HEALTHCARE AUTHORITY, BIBB MEDICAL CENTER | 636005283 | AL | General Acute Care Hospital (282N00000X) |
United | J9250 | $0.33 | 1326442336 - THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY, ATRIUM HEALTH CLEVELAND | 560529945 | NC | General Acute Care Hospital (282N00000X) |
United | J9250 | $0.31 | 1609873504 - JESUS GOMEZ | 204736578 | TX | Medical Oncology Physician (207RX0202X) |
United | J9250 | $0.33 | 1821475138 - DIVYA ASTI | 742915297 - (TX) SOUTH TEXAS ONCOLOGY & HEMATOLOGY, PLLC | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9250 | $0.33 | 1306863055 - ANUPAMA PANT DHODAPKAR | 760326352 - (TX) EMERARDO FALCON, JR., M.D., P.A. DBA BRAZOSPORT HEMATOLOGY-ONCOLOGY | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9250 | $0.33 | 1932553385 - BBH WBMC, LLC, WALKER BAPTIST MEDICAL CENTER | 474790386 | AL | General Acute Care Hospital (282N00000X) |
United | J9250 | $0.37 | 1619209574 - VALLEY MEDICAL GROUP-RENTON, PUBLIC HOSPITAL DISTRICT #1 OF KING COUNTY | 271209674 | WA | General Acute Care Hospital (282N00000X) |
United | J9250 | $0.34 | 1427081710 - DAVID ELLENT | 412273820 - (TX) STEPHEN F AUSTIN COMMUNITY HEALTH CENTER INC | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9250 | $0.41 | 1497835680 - CHRISTOPHER BRADEN | 752131429 - US ONCOLOGY CORPORATE, INC. | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9250 | $0.33 | 1033290168 - NADEEM QURASHI | 760615938 - (TX) NADEEM QURASHI, M.D., P.A. | TX | Medical Oncology Physician (207RX0202X) |
United | J9250 | $0.43 | 1326482860 - ROHAN GUPTA | 274803222 - CITY OF HOPE MEDICAL FOUNDATION | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9250 | $0.33 | 1962419804 - SOUTHEAST TEXAS ONCOLOGY PARTNERS | 760039691 - (TX) SOUTHEAST TEXAS ONCOLOGY PARTNERS | TX | Medical Oncology Physician (207RX0202X) |
United | J9250 | $0.34 | 1013918747 - CLEVELAND COUNTY HEALTHCARE SYSTEM, CLEVELAND REGIONAL MEDICAL CENTER | 560529945 | NC | General Acute Care Hospital (282N00000X) |
United | J9250 | $0.41 | 1154369775 - DEMETRIUS LOUKAS | 752131429 - US ONCOLOGY CORPORATE, INC. | TX | Medical Oncology Physician (207RX0202X) |
United | J9250 | $0.33 | 1699877795 - RAMESH KARIA | 742140380 | TX | 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 J9250 vs. Other Chemotherapy Drugs Codes
The HCPCS J9250 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 J9250 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 |
|---|---|---|
| J9247-HCPCS | Moderate | Injection, melphalan flufenamide, 1mg |
| J9250-HCPCS | Low | Methotrexate sodium, 5 mg |
| J9259-HCPCS | Low | Injection, paclitaxel protein-bound particles (american regent) not therapeutically equivalent to j9264, 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 J9250. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J9250 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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