HCPCS J9305 (Alimta) 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 | $4.355  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
| Related NDC Codes | • 00002-7623-01 - ALIMTA 500 MG • 00002-7640-01 - ALIMTA (SINGLE-USE) 100 MG • 16729-0229-03 - PEMETREXED (SDV,PF,LATEX-FREE) 100 MG • 16729-0230-11 - PEMETREXED (SDV,PF,LATEX-FREE) 500 MG • 25021-0260-10 - PEMETREXED SDV,LYOPHILIZED 100 MG |
National average reimbursement for HCPCS J9305 by major payers:
$7.38
$6.57
$11.23
$6.14
| 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 J9305 | ||||||
United | J9305 | $5.26 | 1003937715 - DAYAL RAJA | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Endocrinology, Diabetes & Metabolism Physician (207RE0101X) |
United | J9305 | $7.92 | 1295729143 - SYED ZAMAN | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Anatomic Pathology & Clinical Pathology Physician (207ZP0102X) |
United | J9305 | $19.70 | 1972938900 - JEFFREY KWASNIEWSKI | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Diagnostic Radiology Physician (2085R0202X) |
United | J9305 | $7.05 | 1417485822 - AHMAD GHORAB | 300791563 - (TX) BAYLOR COLLEGE OF MEDICINE / CONTEMPORARY MEDICINE ASSOCIATES PLLC / ST LUKES COMMUNITY DEVELOPMENT CORPORATION | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9305 | $6.75 | 1548325582 - GEORGIA MCCANN | 741586031 - AMY HALANSKI MD PC / AUSTIN PATHOLOGY ASSOCIATES / BEXAR COUNTY HOSPITAL DISTRICT | TX | Gynecologic Oncology Physician (207VX0201X) |
United | J9305 | $7.21 | 1609286756 - TRI LE | 752131429 - US ONCOLOGY CORPORATE, INC. | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9305 | $5.26 | 1346929247 - ALEXIS VIRAY-EDWARDS | 751646450 - (TX) ARTHRITIS CENTERS OF TEXAS PA | TX | Rheumatology Physician (207RR0500X) |
United | J9305 | $5.86 | 1881728616 - CLINICAL ONCOLOGY & HEMATOLOGY, LLP | 203687364 - (TX) CLINICAL ONCOLOGY HEMATOLOGY LLP | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9305 | $10.14 | 1396933370 - SHERRONDA HENDERSON | 742958277 - SCOTT & WHITE CLINIC | TX | Medical Oncology Physician (207RX0202X) |
United | J9305 | $19.70 | 1831182542 - BRUNO APLOKS | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Otolaryngology Physician (207Y00000X) |
United | J9305 | $7.05 | 1881950012 - ALFREDO ECHEVERRIA | 741613878 - (TX) BAYLOR COLLEGE OF MEDICINE | TX | Radiation Oncology Physician (2085R0001X) |
United | J9305 | $7.92 | 1962453647 - MAURICIO VALENCIA | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Family Medicine Physician (207Q00000X) |
United | J9305 | $5.26 | 1992793137 - KAREN FLICK | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Nurse Practitioner (363L00000X) |
United | J9305 | $19.70 | 1962464818 - JOHN ELLIS | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Diagnostic Radiology Physician (2085R0202X) |
United | J9305 | $7.21 | 1629067533 - KIRAN KANCHARLA | 752131429 - US ONCOLOGY CORPORATE, INC. | TX | Hematology & Oncology Physician (207RH0003X) |
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 J9305 vs. Other Chemotherapy Drugs Codes
The HCPCS J9305 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 J9305 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 |
|---|---|---|
| 00002-7623-01-NDC | Moderate | ALIMTA 500 MG |
| 00002-7640-01-NDC | Moderate | ALIMTA (SINGLE-USE) 100 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 J9305. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J9305 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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