HCPCS J9260 (Methotrexate) 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 • 99 - Other POS |
| Complexity Level | Low |
| Medicare Payment Limit | $2.816  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
| Related NDC Codes | • 00143-9367-01 - METHOTREXATE NOVAPLUS (SDV;USP,PF,LATEX-FREE) 1 GM • 00143-9519-10 - METHOTREXATE SODIUM (10X2ML SDV,PF) 25 MG/1 ML • 00143-9830-01 - METHOTREXATE (SINGLE USE VIAL,PF) 1 GM • 59137-0510-04 - RASUVO (1X4 AUTO INJECTORS,PF) 10 MG/0.2 ML • 61703-0124-40 - PREMIERPRO RX METHOTREXATE (SDV,PF,LATEX-FREE) 25 MG/1 ML |
National average reimbursement for HCPCS J9260 by major payers:
$2.82
$3.00
$3.09
$2.92
| 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 J9260 | ||||||
United | J9260 | $3.36 | 1548295306 - SETH COHEN | 454832340 | NJ | Medical Oncology Physician (207RX0202X) |
United | J9260 | $3.71 | 1093715369 - STEVEN YOUNG | 852303328 | NJ | Hematology & Oncology Physician (207RH0003X) |
United | J9260 | $2.86 | 1033108782 - BRUCE HAFFTY | 222810004 | NJ | Radiation Oncology Physician (2085R0001X) |
United | J9260 | $3.36 | 1235404450 - ROMAN GROISBERG | 223146927 | NJ | Medical Oncology Physician (207RX0202X) |
United | J9260 | $2.57 | 1053502732 - RABIA CATTIE | 223266219 | NJ | Hematology & Oncology Physician (207RH0003X) |
United | J9260 | $3.55 | 1831269539 - MISSOURI DELTA MEDICAL CENTER | 430633449 - MISSOURI DELTA MEDICAL CENTER | MO | General Acute Care Hospital (282N00000X) |
United | J9260 | $3.71 | 1689642126 - STEVEN ZARNY | 223141761 | NJ | Radiation Oncology Physician (2085R0001X) |
United | J9260 | $3.71 | 1346202439 - MICHELE DONATO | 223141761 | NJ | Medical Oncology Physician (207RX0202X) |
United | J9260 | $3.56 | 1235163833 - DAVID SOKOL | 264203938 | NJ | Hematology & Oncology Physician (207RH0003X) |
United | J9260 | $2.64 | 1013924372 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION, METROPOLITAN HOSPITAL CENTER | 132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | NY | General Acute Care Hospital (282N00000X) |
United | J9260 | $3.88 | 1710915269 - PRIYA GOR | 232865181 | NJ | Hematology & Oncology Physician (207RH0003X) |
United | J9260 | $3.67 | 1316320237 - ASHWIN CHANDAR | 464855345 | NJ | Hematology & Oncology Physician (207RH0003X) |
United | J9260 | $3.47 | 1104169515 - LINDA CHEN | 593801080 | NJ | Radiation Oncology Physician (2085R0001X) |
United | J9260 | $3.36 | 1588157895 - GREGORY ALEXANDER | 461420853 | NJ | Radiation Oncology Physician (2085R0001X) |
United | J9260 | $3.56 | 1700880069 - JONATHAN BRIGGS | 823157047 | NJ | Radiation Oncology Physician (2085R0001X) |
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 J9260 vs. Other Chemotherapy Drugs Codes
The HCPCS J9260 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 J9260 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 |
|---|---|---|
| 00143-9367-01-NDC | Moderate | METHOTREXATE NOVAPLUS (SDV;USP,PF,LATEX-FREE) 1 GM |
| J9259-HCPCS | Low | Injection, paclitaxel protein-bound particles (american regent) not therapeutically equivalent to j9264, 1 mg |
| J9260-HCPCS | Low | Methotrexate sodium, 50 mg |
| J9261-HCPCS | Low | Injection, nelarabine, 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 J9260. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J9260 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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