HCPCS J9259 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 • 22 - On Campus Outpatient Hospital |
| Complexity Level | Low |
National average reimbursement for HCPCS J9259 by major payers:
$16.29
$18.08
$22.02
$17.16
| 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 J9259 | ||||||
United | J9259 | $16.87 | 1023003969 - HEART HOSPITAL OF SOUTH DAKOTA LLC, AVERA HEART HOSPITAL OF SOUTH DAKOTA LLC | 562143771 - (SD) AVERA HEALTH | SD | General Acute Care Hospital (282N00000X) |
United | J9259 | $22.62 | 1316023476 - SVETLANA GRINBLAT | 132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | NY | General Acute Care Hospital (282N00000X) |
United | J9259 | $16.87 | 1528006103 - BRYAN MEDICAL CENTER | 470376552 - BRYAN MEDICAL CENTER | NE | General Acute Care Hospital (282N00000X) |
United | J9259 | $16.87 | 1295736734 - CHRISTUS HEALTH ARK-LA-TEX, CHRISTUS ST. MICHAEL HEALTH SYSTEM | 752616977 - CHRISTUS TRINITY CLINIC | TX | General Acute Care Hospital (282N00000X) |
United | J9259 | $16.87 | 1427112473 - PHYSICIANS MEDICAL CENTER OF SANTA FE, LLC | 432091403 - (NM) PHYSICIANS MEDICAL CENTER OF SANTA FE LLC | NM | General Acute Care Hospital (282N00000X) |
United | J9259 | $16.87 | 1649431388 - HCA PHYSICIAN SERVICES | 621821475 - (FL) HCA PHYSICIAN SERVICES, INC. | FL | General Acute Care Hospital (282N00000X) |
United | J9259 | $17.88 | 1104956358 - KALEIDA HEALTH, DEGRAFF HOSPITAL | 161533232 - KALEIDA HEALTH | NY | General Acute Care Hospital (282N00000X) |
United | J9259 | $17.88 | 1235306648 - ST. FRANCIS RADIOLOGISTS, LLC | 475419443 | GA | General Acute Care Hospital (282N00000X) |
United | J9259 | $15.35 | 1649431388 - HCA PHYSICIAN SERVICES | 621821475 - (FL) HCA PHYSICIAN SERVICES, INC. | FL | General Acute Care Hospital (282N00000X) |
United | J9259 | $20.40 | 1659633154 - MAHRAN SHOUKIER | 760605200 - (TX) ONCOLOGY CONSULTANTS, P.A. | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9259 | $17.88 | 1992792402 - ALEXANDER WONG | 205502422 - (TX) ALEXANDER WONG MDPA | TX | Medical Oncology Physician (207RX0202X) |
United | J9259 | $23.12 | 1205079373 - ANDRAE VANDROSS | 752131429 - US ONCOLOGY CORPORATE, INC. | TX | Medical Oncology Physician (207RX0202X) |
United | J9259 | $18.79 | 1780875096 - VINU MADHUSUDANANNAIR | 742915297 - (TX) SOUTH TEXAS ONCOLOGY & HEMATOLOGY, PLLC | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9259 | $16.87 | 1659340370 - SKY LAKES MEDICAL CENTER INC | 930508781 - SKY LAKES MEDICAL CENTER INC | OR | General Acute Care Hospital (282N00000X) |
United | J9259 | $17.88 | 1982625661 - NICHOLAS H. NOYES MEMORIAL HOSPITAL | 160743979 - (NY) NICHOLAS H NOYES MEMORIAL HOSPITAL | NY | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
HCPCS J9259 vs. Other Chemotherapy Drugs Codes
The HCPCS J9259 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 J9259 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 |
|---|---|---|
| J9250-HCPCS | Low | Methotrexate sodium, 5 mg |
| J9259-HCPCS | Low | Injection, paclitaxel protein-bound particles (american regent) not therapeutically equivalent to j9264, 1 mg |
| J9260-HCPCS | Low | Methotrexate sodium, 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 J9259. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J9259 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like HCPCS J9259) and we'll show you how you compare in 15 minutes or less.