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 | $0.33 | 1487757084 - LEE DRINKARD | 431598353 - SAINT LUKES PHYSICIAN GROUP INC | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9250 | $0.31 | 1609873504 - JESUS GOMEZ | 204736578 | TX | Medical Oncology Physician (207RX0202X) |
United | J9250 | $0.37 | 1225266596 - SHEENA SAHOTA | 770465765 | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9250 | $0.33 | 1780875096 - VINU MADHUSUDANANNAIR | 742915297 - (TX) SOUTH TEXAS ONCOLOGY & HEMATOLOGY, PLLC | 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 | $0.41 | 1942294608 - ROBERT PRIETO | 752131429 - US ONCOLOGY CORPORATE, INC. | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9250 | $0.36 | 1164420105 - MOHAMMED SABBAGH | 824681345 | TX | Medical Oncology Physician (207RX0202X) |
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 | $0.37 | 1619209574 - VALLEY MEDICAL GROUP-RENTON, PUBLIC HOSPITAL DISTRICT #1 OF KING COUNTY | 271209674 | WA | General Acute Care Hospital (282N00000X) |
United | J9250 | $0.33 | 1114922531 - AMANULLAH KHAN | 751312419 - (TX) CANCER CENTER ASSOCIATES | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9250 | $0.34 | 1053380576 - ANNE ARUNDEL MEDICAL CENTER, INC, AAMC-PEDIATRIC HOSPITALISTS | 201838374 | MD | General Acute Care Hospital (282N00000X) |
United | J9250 | $0.31 | 1710396486 - AMIT CORREA | 922465140 | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9250 | $0.33 | 1699877795 - RAMESH KARIA | 742140380 | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9250 | $0.33 | 1700827839 - SYED RAZA | 472050793 - (TX) ONCOLOGY SAN ANTONIO | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9250 | $0.41 | 1154369775 - DEMETRIUS LOUKAS | 752131429 - US ONCOLOGY CORPORATE, INC. | TX | Medical Oncology Physician (207RX0202X) |
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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