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 | $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 | $48.22 | 1356720841 - ANDREW FARACH | 300520570 - (TX) METHODIST HOSPITAL | TX | Radiation Oncology Physician (2085R0001X) |
United | J9317 | $35.43 | 1659427334 - ROBERT KOVAL | 842136648 - (TX) ORTHOLONESTAR, PLLC | TX | Rheumatology Physician (207RR0500X) |
United | J9317 | $48.22 | 1093169831 - DONNA JOSE | 300520570 - (TX) METHODIST HOSPITAL | TX | Rheumatology Physician (207RR0500X) |
United | J9317 | $37.56 | 1609846641 - EVERETT ALLEN | 161751617 - (TX) RHEUMATOLOGY ASSOCIATES OF SOUTH TEXAS PLLC | TX | Rheumatology Physician (207RR0500X) |
United | J9317 | $35.43 | 1659581502 - ELIZABETH SOLOW | 756002868 - ABKSW PREFERRED HEALTH PARTNERS PLLC / ACTION FAMILY CARE PLLC / ADAM S MINER MD PA | TX | Rheumatology Physician (207RR0500X) |
United | J9317 | $42.16 | 1437215886 - JOSHUA GARREN | 383983999 - CHRISTOPHER M MANUS MD PC / OKLAHOMA CANCER SPECIALISTS AND RESEARCH INSTITUTE LLC | TX | Radiation Oncology Physician (2085R0001X) |
United | J9317 | $35.43 | 1902392954 - DFW RHEUMATOLOGY, PLLC | 830776929 - (TX) DFW RHEUMATOLOGY PLLC | TX | Rheumatology Physician (207RR0500X) |
United | J9317 | $48.56 | 1346282209 - BILLIE MAREK | 752131429 - US ONCOLOGY CORPORATE, INC. | TX | Medical Oncology Physician (207RX0202X) |
United | J9317 | $35.43 | 1366601924 - LAURA TENNER | 470785575 - (NE) UNMC PHYSICIANS | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9317 | $68.22 | 1457448292 - AYESHA SHEIKH | 742958277 - SCOTT & WHITE CLINIC | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9317 | $36.50 | 1205168887 - PUNEETH IYENGAR | 300937486 - JAMIE J VOCCOLA / MEMORIAL SLOAN KETTERING CANCER CENTER AT BASKING RIDGE NEW JERSEY / MSK MONMOUTH | TX | Radiation Oncology Physician (2085R0001X) |
United | J9317 | $39.45 | 1821785643 - TITUS COUNTY HOSPITAL DISTRICT, CANCER CARE AT TITUS | 756003935 - RWJBH OBSERVATION ASSOCIATES LLC / TITUS COUNTY HOSPITAL DISTRICT / TITUS REGIONAL MEDICAL CENTER | TX | Oncology Clinic/Center (261QX0200X) |
United | J9317 | $40.04 | 1043291347 - AJIT DAVE | 752459024 - (TX) AJIT DAVE MD PA | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9317 | $35.43 | 1124128749 - DEMETRIOS PETROPOULOS | 760459500 - U T PHYSICIANS | 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 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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