HCPCS J9280 (Mitomycin) 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 • 24 - Ambulatory Surgical Center |
| Complexity Level | Low |
| Medicare Payment Limit | $20.348  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
| Related NDC Codes | • 00143-9135-01 - MITOMYCIN NOVAPLUS (LATEX-FREE) 20 MG • 00143-9136-01 - MITOMYCIN NOVAPLUS (LATEX-FREE) 40 MG • 00143-9279-01 - MITOMYCIN 20 MG • 00143-9280-01 - MITOMYCIN 40 MG • 25021-0250-20 - MITOMYCIN (USP,PF,LATEX-FREE) 5 MG |
National average reimbursement for HCPCS J9280 by major payers:
$52.23
$52.67
$60.27
$48.36
| 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 J9280 | ||||||
United | J9280 | $54.15 | 1861447179 - AURORA HEALTH CARE METRO, INC. | 390806181 - AURORA HEALTH CARE INC | WI | General Acute Care Hospital (282N00000X) |
United | J9280 | $73.12 | 1588151401 - SOPHIA LEE | 752131429 - US ONCOLOGY CORPORATE, INC. | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9280 | $73.12 | 1588151401 - SOPHIA LEE | 752131429 - US ONCOLOGY CORPORATE, INC. | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9280 | $163.85 | 1134227606 - SOUTH SHORE HOSPITAL INC. | 42769210 - SOUTH SHORE HOSPITAL INC | MA | General Acute Care Hospital (282N00000X) |
United | J9280 | $64.45 | 1427292135 - NEW YORK UNIVERSITY LANGONE MEDICAL CENTER | 135562308 - NEW YORK UNIVERSITY | NY | General Acute Care Hospital (282N00000X) |
United | J9280 | $52.38 | 1609822881 - COMMUNITY MEMORIAL HOSPITAL OF MENOMONEE FALLS INC, FROEDTERT MENOMONEE FALLS HOSPITAL | 390987025 - (WI) COMMUNITY MEMORIAL HOSPITAL OF MENOMONEE FALLS INC | WI | General Acute Care Hospital (282N00000X) |
United | J9280 | $57.40 | 1083644579 - BRONSON BATTLE CREEK HOSPITAL | 382776791 - (MI) BRONSON BATTLE CREEK HOSPITAL | MI | General Acute Care Hospital (282N00000X) |
United | J9280 | $42.50 | 1043529282 - BAY AREA MEDICA CENTER | 391528430 - AURORA MEDICAL CENTER BAY AREA INC | WI | General Acute Care Hospital (282N00000X) |
United | J9280 | $98.77 | 1295789907 - CAROLINAS MEDICAL CENTER | 561398929 | NC | General Acute Care Hospital (282N00000X) |
United | J9280 | $42.50 | 1366573263 - KING'S DAUGHTERS MEDICAL CENTER | 640333594 - KINGS DAUGHTERS MEDICAL CENTER | MS | General Acute Care Hospital (282N00000X) |
United | J9280 | $33.33 | 1629316237 - RUCHI UPADHYAY | 132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | NY | General Acute Care Hospital (282N00000X) |
United | J9280 | $62.11 | 1649350380 - MVHS INC, MOHAWK VALLEY HEALTH SYSTEM INC | 161576637 - FAXTON-ST LUKES HEALTHCARE | NY | General Acute Care Hospital (282N00000X) |
United | J9280 | $46.34 | 1912343807 - POORNI MANOHAR | 756002868 - ABKSW PREFERRED HEALTH PARTNERS PLLC / ACTION FAMILY CARE PLLC / ADAM S MINER MD PA | TX | Medical Oncology Physician (207RX0202X) |
United | J9280 | $60.47 | 1073711065 - MEDSTAR GEORGETOWN MEDICAL CENTER, INC, GEORGETOWN UNIVERSITY HOSPITAL PHYSICIANS | 522218584 - (DC) MEDSTAR-GEORGETOWN MEDICAL CENTER INC | DC | General Acute Care Hospital (282N00000X) |
United | J9280 | $46.34 | 1982806477 - TAMRA SLONE | 756002868 - ABKSW PREFERRED HEALTH PARTNERS PLLC / ACTION FAMILY CARE PLLC / ADAM S MINER MD PA | TX | Pediatric Hematology & Oncology Physician (2080P0207X) |
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 J9280 vs. Other Chemotherapy Drugs Codes
The HCPCS J9280 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 J9280 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 |
|---|---|---|
| 00143-9135-01-NDC | Moderate | MITOMYCIN NOVAPLUS (LATEX-FREE) 20 MG |
| 00143-9136-01-NDC | Moderate | MITOMYCIN NOVAPLUS (LATEX-FREE) 40 MG |
| 00143-9279-01-NDC | Moderate | MITOMYCIN 20 MG |
| J9280-HCPCS | Low | Injection, mitomycin, 5 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J9280. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J9280 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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