HCPCS J9317 (Trodelvy) 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 | $36.276  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
| Related NDC Codes | • 55135-0132-01 - TRODELVY (PF,LYOPHILIZED) 180 MG |
National average reimbursement for HCPCS J9317 by major payers:
$36.99
$37.16
$38.35
$36.72
| 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 J9317 | ||||||
United | J9317 | $47.49 | 1295975878 - CARY HSU | 741613878 - (TX) BAYLOR COLLEGE OF MEDICINE | TX | Surgical Oncology Physician (2086X0206X) |
United | J9317 | $35.43 | 1235626839 - MOHAMMAD ABU ARJA | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Pediatric Hematology & Oncology Physician (2080P0207X) |
United | J9317 | $39.45 | 1285684944 - BIJAL MODI | 351978245 - (IN) HEALTH ONCOLOGY SERVICES INC | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9317 | $52.84 | 1942395496 - LAILA HASSAN | 760438451 | TX | Rheumatology Physician (207RR0500X) |
United | J9317 | $37.56 | 1770842098 - LAREDO ARTHRITIS & RHEUMATOLOGY CENTER, PLLC, LAREDO ARTHRITIS & RHEUMATOLOGY CENTER,PLLC | 454951652 - (TX) LAREDO ARTHRITIS RHEUMATOLOGY CENTER PLLC | TX | Rheumatology Physician (207RR0500X) |
United | J9317 | $35.43 | 1780631911 - JOHN LOHREY | 756002868 - ABKSW PREFERRED HEALTH PARTNERS PLLC / ACTION FAMILY CARE PLLC / ADAM S MINER MD PA | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9317 | $39.45 | 1669868659 - LAUREN RAMSEY | 352526373 - ACCLAIM PHYSICIAN GROUP INC | TX | Surgical Oncology Physician (2086X0206X) |
United | J9317 | $47.34 | 1629021159 - ONCOLOGY-HEMATOLOGY CONSULTANTS PA, THE CENTER FOR CANCER AND BLOOD DISORDERS | 752512142 - (TX) ONCOLOGYHEMATOLOGY CONSULTANTS PA | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9317 | $35.43 | 1447293899 - RICHARD HELMER | 742696970 - PROVIDENCE HEALTH ALLIANCE INC | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9317 | $45.36 | 1861495343 - JOHN SARANTOPOULOS | 741586031 - AMY HALANSKI MD PC / AUSTIN PATHOLOGY ASSOCIATES / BEXAR COUNTY HOSPITAL DISTRICT | TX | Medical Oncology Physician (207RX0202X) |
United | J9317 | $70.25 | 1861526048 - LISA MADDEN | 680334324 - BERK STREET ENTERPRISES LLC / HAYWARD SISTERS HOSPITAL / HISHAM SOLIMAN MD INC | TX | Pediatric Hematology & Oncology Physician (2080P0207X) |
United | J9317 | $34.09 | 1538138011 - POOJA BANERJEE | 800457000 - (TX) NORTH TEXAS RHEUMATOLOGY PA | TX | Rheumatology Physician (207RR0500X) |
United | J9317 | $45.36 | 1164553616 - CANCER THERAPY AND RESEARCH CENTER | 741586031 - AMY HALANSKI MD PC / AUSTIN PATHOLOGY ASSOCIATES / BEXAR COUNTY HOSPITAL DISTRICT | TX | Radiation Oncology Clinic/Center (261QX0203X) |
United | J9317 | $35.43 | 1538138011 - POOJA BANERJEE | 800457000 - (TX) NORTH TEXAS RHEUMATOLOGY PA | TX | Rheumatology Physician (207RR0500X) |
United | J9317 | $39.45 | 1033433420 - PRO PHYSICIANS CLINIC PA | 263674950 - PRO PHYSICIANS CLINIC PA | TX | Radiation Oncology Physician (2085R0001X) |
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 J9317 vs. Other Chemotherapy Drugs Codes
The HCPCS J9317 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 J9317 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 |
|---|---|---|
| 55135-0132-01-NDC | Moderate | TRODELVY (PF,LYOPHILIZED) 180 MG |
| J9316-HCPCS | Low | Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg |
| J9317-HCPCS | Low | Injection, sacituzumab govitecan-hziy, 2.5 mg |
| J9318-HCPCS | Low | Injection, romidepsin, non-lyophilized, 0.1 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J9317. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J9317 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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