HCPCS J9304 (Pemfexy) 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 |
| Complexity Level | Low |
| Medicare Payment Limit | $46.321  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J9304 by major payers:
$58.52
$56.52
$60.28
$54.74
| 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 J9304 | ||||||
United | J9304 | $67.47 | 1972512200 - SHAFQAT SHAH | 741586031 - AMY HALANSKI MD PC / AUSTIN PATHOLOGY ASSOCIATES / BEXAR COUNTY HOSPITAL DISTRICT | TX | Pediatric Hematology & Oncology Physician (2080P0207X) |
United | J9304 | $63.70 | 1649441601 - RICARDO ALVAREZ | 760605200 - (TX) ONCOLOGY CONSULTANTS, P.A. | TX | Medical Oncology Physician (207RX0202X) |
United | J9304 | $52.70 | 1588078976 - JOYCE VARKEY | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Pediatric Hematology & Oncology Physician (2080P0207X) |
United | J9304 | $72.22 | 1568404481 - MICHAEL PARK | 752131429 - US ONCOLOGY CORPORATE, INC. | TX | Medical Oncology Physician (207RX0202X) |
United | J9304 | $58.66 | 1538162029 - AMITA PATNAIK | 742915297 - (TX) SOUTH TEXAS ONCOLOGY AND HEMATOLOGY PLLC | TX | Medical Oncology Physician (207RX0202X) |
United | J9304 | $58.66 | 1861998007 - BRADLY KIMBROUGH | 812174373 - (TX) AMERICAN ARTHRITIS RHEUMATOLOGY ASSOCIATESTX PLLC / HEARTPLACE PLLC / NORTH TEXAS RHEUMATOLOGY PA | TX | Rheumatology Physician (207RR0500X) |
United | J9304 | $58.66 | 1073042859 - WOMEN'S ONCOLOGY, PLLC | 821742975 - (TX) WOMENS ONCOLOGY PLLC | TX | Gynecologic Oncology Physician (207VX0201X) |
United | J9304 | $58.66 | 1639360829 - JOHN KNECHT | 412273820 - (TX) STEPHEN F AUSTIN COMMUNITY HEALTH CENTER INC | TX | Medical Oncology Physician (207RX0202X) |
United | J9304 | $52.70 | 1639360829 - JOHN KNECHT | 203395567 - COMMUNITY CARE SERVICES LLC / EAST JEFFERSON PHYSICIANS GROUP LLC / EASTERN SIERRA MEDICAL GROUP LLC | TX | Medical Oncology Physician (207RX0202X) |
United | J9304 | $52.70 | 1639360829 - JOHN KNECHT | 202798379 - (TX) CLS HEALTH PLLC | TX | Medical Oncology Physician (207RX0202X) |
United | J9304 | $52.70 | 1639360829 - JOHN KNECHT | 473346719 - (TX) CLEAR LAKE ONCOLOGY PLLC | TX | Medical Oncology Physician (207RX0202X) |
United | J9304 | $52.70 | 1972512200 - SHAFQAT SHAH | 742932237 - (TX) COMMUNITY MEDICINE ASSOCIATES | TX | Pediatric Hematology & Oncology Physician (2080P0207X) |
United | J9304 | $55.86 | 1568447563 - KENNETH DESROSIER | 272571855 - (TX) RHEUMATOLOGY SOLUTIONS PLLC | TX | Rheumatology Physician (207RR0500X) |
United | J9304 | $70.62 | 1366947210 - JASON RAGGI | 61578286 - DOWNTOWN BRONX MEDICAL ASSOCIATES PC | NY | General Acute Care Hospital (282N00000X) |
United | J9304 | $55.86 | 1033214440 - JOHNSTON MEMORIAL HOSPITAL, JOHNSTON MEMORIAL HOSPITAL ER PHYSICIANS | 540544705 - JOHNSTON MEMORIAL HOSPITAL INC | VA | 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 |
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HCPCS J9304 vs. Other Chemotherapy Drugs Codes
The HCPCS J9304 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 J9304 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 |
|---|---|---|
| J9303-HCPCS | Low | Injection, panitumumab, 10 mg |
| J9304-HCPCS | Low | Injection, pemetrexed (pemfexy), 10 mg |
| J9305-HCPCS | Low | Injection, pemetrexed, not otherwise specified, 10 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J9304. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J9304 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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