HCPCS J9264 (Abraxane) 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 |
| Medicare Payment Limit | $10.543  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
| Related NDC Codes | • 00480-3290-01 - PACLITAXEL PROTEIN-BOUND PARTICLES (ALBUMIN-BOUND) 100 MG • 00517-4300-01 - PACLITAXEL PROTEIN-BOUND PARTICLES ALBUMIN-BOUND,LYOPHILIZED 100 MG • 00781-3531-91 - PACLITAXEL PROTEIN-BOUND PARTICLES ALBUMIN-BOUND,LYOPHILIZED 100 MG • 60505-6230-04 - PACLITAXEL PROTEIN-BOUND PARTICLES 100 MG • 68001-0651-37 - PACLITAXEL PROTEIN-BOUND PARTICLES ALBUMIN-BOUND,LYOPHILIZED 100 MG |
National average reimbursement for HCPCS J9264 by major payers:
$14.83
$14.53
$14.92
$14.15
| 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 J9264 | ||||||
United | J9264 | $15.06 | 1033358692 - PRO PHYSICIANS CLINIC PA | 263674950 - PRO PHYSICIANS CLINIC PA | TX | Radiation Oncology Physician (2085R0001X) |
United | J9264 | $17.97 | 1285602565 - ALAIN MITA | 330676831 - HOAG CLINIC INC | TX | Medical Oncology Physician (207RX0202X) |
United | J9264 | $13.53 | 1922195700 - JEFFERY HANRAHAN | 203395567 - COMMUNITY CARE SERVICES LLC / EAST JEFFERSON PHYSICIANS GROUP LLC / EASTERN SIERRA MEDICAL GROUP LLC | TX | Pediatric Hematology & Oncology Physician (2080P0207X) |
United | J9264 | $18.43 | 1578597324 - NABEEL SHALAN | 300520570 - (TX) METHODIST HOSPITAL | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9264 | $18.07 | 1750541900 - NEELEMA PINNAPUREDDY | 752512142 - (TX) ONCOLOGYHEMATOLOGY CONSULTANTS PA | TX | Medical Oncology Physician (207RX0202X) |
United | J9264 | $18.13 | 1164684213 - JULIE NANGIA | 741613878 - (TX) BAYLOR COLLEGE OF MEDICINE | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9264 | $13.53 | 1689014920 - MATTHEW BERRIOS | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | PA | Emergency Medicine Physician (207P00000X) |
United | J9264 | $15.06 | 1265675854 - DANIEL ARSENAULT | 461522270 - (TX) BSA PHYSICIANS GROUP INC | TX | Radiation Oncology Physician (2085R0001X) |
United | J9264 | $13.53 | 1750523692 - ARIF SHAHZAD | 731388879 - (OK) / COMANCHE COUNTY HEALTHCARE / COMANCHE COUNTY HEALTHCARE CORP | TX | Rheumatology Physician (207RR0500X) |
United | J9264 | $18.13 | 1518063486 - MARINA KONOPLEVA | 131740114 - MONTEFIORE MEDICAL CENTER | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9264 | $13.53 | 1518200930 - SAMANTHA SHAPIRO | 42103881 - BETH ISRAEL DEACONESS MEDICAL CENTER INC | TX | Rheumatology Physician (207RR0500X) |
United | J9264 | $13.53 | 1487824769 - JONATHAN CHENG | 472200066 - (TX) CLEAR SKIN CANCER CENTER LLC | TX | Radiation Oncology Physician (2085R0001X) |
United | J9264 | $26.05 | 1508123456 - SAMEER JHAVAR | 742958277 - SCOTT & WHITE CLINIC | TX | Radiation Oncology Physician (2085R0001X) |
United | J9264 | $18.54 | 1417995499 - KARTIK KONDURI | 752131429 - US ONCOLOGY CORPORATE, INC. | TX | Medical Oncology Physician (207RX0202X) |
United | J9264 | $13.53 | 1134474653 - DAVID KUNG | 742109824 - (TX) AUSTIN REGIONAL CLINIC PA / MCBROOM CLINIC PA | TX | Rheumatology Physician (207RR0500X) |
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 J9264 vs. Other Chemotherapy Drugs Codes
The HCPCS J9264 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 J9264 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 |
|---|---|---|
| 00480-3290-01-NDC | Moderate | PACLITAXEL PROTEIN-BOUND PARTICLES (ALBUMIN-BOUND) 100 MG |
| J9263-HCPCS | Low | Injection, oxaliplatin, 0.5 mg |
| J9264-HCPCS | Low | Injection, paclitaxel protein-bound particles, 1 mg |
| J9266-HCPCS | High | Injection, pegaspargase, per single dose vial |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J9264. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J9264 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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