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See a sample rate comparisonHCPCS J9316 (Phesgo) Fee Schedule
Last Verified: October 2026
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.
Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg
| Key Fact | Detail |
|---|---|
| Service Type | Chemotherapy Drugs |
| Common Place of Service | None 11 - Office |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for J9316 |
| Medicare Payment Limit | $62.098  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J9316 by major payers:
$71.93
$69.85
$72.67
$68.68
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HCPCS J9316
5 of 25 sample ratesHigher to lower in this preview
Michael Wu
Kelsey-Seybold Medical Group PLLC
$303.76Published rateEmmalind Aponte
Us Oncology Corporate, Inc.
$87.54Published rateJaved Shinwari
Bsa Harrington Physicians Inc / Bsa Hospital LLC / Harrington Physicians Inc
$71.11Published rateOluwaseun Olaiya
Texas Childrens Physician Group
$63.88Published rateAngela Christensen
Abbeville General Hospital / Ayda Garza Montalvo / Fuad Zayed Md PA
$63.88Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS J9316 vs. Other Chemotherapy Drugs Codes
The HCPCS J9316 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 J9316 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 |
|---|---|---|
| J9314-HCPCS | Low | Injection, pemetrexed (teva), not therapeutically equivalent to j9305, 10 mg |
| J9316-HCPCS | Low | Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg |
| J9317-HCPCS | Low | Injection, sacituzumab govitecan-hziy, 2.5 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J9316. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J9316 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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