HCPCS J9321 (Epkinly) 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 |
| Complexity Level | Low |
| Medicare Payment Limit | $55.841  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J9321 by major payers:
$58.07
$55.22
$108.33
$65.80
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | J9321 | $42.47 | 1760828016 - SCOT NIGLIO | 132655001 | NJ | Medical Oncology Physician (207RX0202X) |
United | J9321 | $56.84 | 1760944714 - DAVID BILLING | 593801080 | NJ | Radiation Oncology Physician (2085R0001X) |
United | J9321 | $55.18 | 1558503797 - UNIVERSITY PHYSICIAN ASSOCIATES OF NEW JERSEY, INC., UNIVERSITY RADIATION/ONCOLOGY ASSOCIATES | 222095812 | NJ | Radiation Oncology Physician (2085R0001X) |
United | J9321 | $60.70 | 1841200706 - EDWARD SOFFEN | 852303328 | NJ | Radiation Oncology Physician (2085R0001X) |
United | J9321 | $65.00 | 1497984330 - OKSANA YASKIV | 453023019 - (NY) NORTH SHORE-LIJ MEDICAL PC | MO | General Acute Care Hospital (282N00000X) |
United | J9321 | $55.79 | 1831484419 - ANUJA KRIPLANI | 133278578 | NJ | Medical Oncology Physician (207RX0202X) |
United | J9321 | $58.50 | 1740222454 - KYUDONG UHM | 383740839 | NJ | Hematology & Oncology Physician (207RH0003X) |
United | J9321 | $54.43 | 1497792527 - UNIVERSITY HEALTHCARE SYSTEM, L.C., TULANE LAKESIDE HOSPITAL | 843390470 - (LA) LCMC HEALTH HOLDINGS INC | LA | General Acute Care Hospital (282N00000X) |
United | J9321 | $54.16 | 1295227130 - GABRIELLA HARMON | 20222140 | NJ | Hematology & Oncology Physician (207RH0003X) |
United | J9321 | $62.91 | 1174597892 - CURATORS OF THE UNIVERSITY OF MISSOURI, CAPITAL REGION MEDICAL CENTER | 900294051 | MO | General Acute Care Hospital (282N00000X) |
United | J9321 | $61.43 | 1497700405 - ENGLEWOOD RADIATION ONCOLOGY, LLC | 223841015 | NJ | Radiation Oncology Physician (2085R0001X) |
United | J9321 | $55.18 | 1083823504 - ANTHONY SCARPACI | 461420853 | NJ | Medical Oncology Physician (207RX0202X) |
United | J9321 | $55.18 | 1235404450 - ROMAN GROISBERG | 223146927 | NJ | Medical Oncology Physician (207RX0202X) |
United | J9321 | $60.70 | 1518165919 - AAMER FAROOQ | 852303328 | NJ | Hematology & Oncology Physician (207RH0003X) |
United | J9321 | $61.25 | 1306887245 - TAMI BACH | 232865181 | NJ | 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 J9321 vs. Other Chemotherapy Drugs Codes
The HCPCS J9321 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 J9321 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 |
|---|---|---|
| J9321-HCPCS | Low | Injection, epcoritamab-bysp, 0.16 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J9321. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J9321 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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