HCPCS J9351 (Hycamtin) 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 | $2.541  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
| Related NDC Codes | • 00078-0674-61 - HYCAMTIN (S.D.V.) 4 MG • 16729-0243-31 - TOPOTECAN (1X4ML;MDV) 1 MG/1 ML • 45963-0615-56 - TOPOTECAN HCL (SDV,PF) 4 MG |
National average reimbursement for HCPCS J9351 by major payers:
$1.72
$3.07
$2.51
$1.79
| 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 J9351 | ||||||
United | J9351 | $1.77 | 1588773824 - GENEROSA GRANA | 223266219 | NJ | Hematology & Oncology Physician (207RH0003X) |
United | J9351 | $1.87 | 1417939810 - WILLIAM LERNER | 223376459 | NJ | Hematology & Oncology Physician (207RH0003X) |
United | J9351 | $2.33 | 1760512826 - NEW YORK PRESBYTERIAN HOSPITAL | 131623978 | NY | General Acute Care Hospital (282N00000X) |
United | J9351 | $0.93 | 1427112473 - PHYSICIANS MEDICAL CENTER OF SANTA FE, LLC | 432091403 - (NM) PHYSICIANS MEDICAL CENTER OF SANTA FE LLC | NM | General Acute Care Hospital (282N00000X) |
United | J9351 | $1.16 | 1346248986 - JOHNSON MEMORIAL HOSPITAL, JOHNSON MEMORIAL HOSPITAL | 351166081 - JOHNSON MEMORIAL HOSPITAL | IN | General Acute Care Hospital (282N00000X) |
United | J9351 | $1.83 | 1184637886 - MEMORIAL SLOAN KETTERING CANCER CENTER AT BASKING RIDGE NEW JERSEY | 133375559 | NJ | Medical Oncology Physician (207RX0202X) |
United | J9351 | $1.79 | 1629076468 - CHRISTUS HEALTH SOUTHWESTERN LOUISIANA, CHRISTUS OCHSNER ST PATRICK HOSPITAL | 720411322 - (LA) CHRISTUS HEALTH SOUTHWESTERN LOUISIANA | LA | General Acute Care Hospital (282N00000X) |
United | J9351 | $7.63 | 1386793313 - INDU SHARMA | 223144262 | NJ | Hematology & Oncology Physician (207RH0003X) |
United | J9351 | $1.77 | 1356442602 - PATRICK LEE | 223316007 | NJ | Hematology (Internal Medicine) Physician (207RH0000X) |
United | J9351 | $3.14 | 1902803315 - REGENTS UNIV OF CALIF LOS ANGELES, RONALD REAGAN UCLA MEDICAL CENTER | 1902803315 - (CA) REGENTS UNIV OF CALIF LOS ANGELES | CA | General Acute Care Hospital (282N00000X) |
United | J9351 | $1.72 | 1306933940 - YAKIMA VALLEY MEMORIAL PHYSICIANS | 753186720 | WA | General Acute Care Hospital (282N00000X) |
United | J9351 | $2.02 | 1316262363 - MANUJ AGARWAL | 202088165 | NJ | Radiation Oncology Physician (2085R0001X) |
United | J9351 | $1.77 | 1972954725 - RADIATION ONCOLOGY GROUP AT SBMC | 812497757 | NJ | Radiation Oncology Physician (2085R0001X) |
United | J9351 | $1.77 | 1265440903 - ADNAN DANISH | 223141761 | NJ | Radiation Oncology Physician (2085R0001X) |
United | J9351 | $1.77 | 1184156622 - VELI BAKALOV | 223266219 | 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 J9351 vs. Other Chemotherapy Drugs Codes
The HCPCS J9351 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 J9351 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 |
|---|---|---|
| 00078-0674-61-NDC | Moderate | HYCAMTIN (S.D.V.) 4 MG |
| 16729-0243-31-NDC | Moderate | TOPOTECAN (1X4ML;MDV) 1 MG/1 ML |
| 45963-0615-56-NDC | Moderate | TOPOTECAN HCL (SDV,PF) 4 MG |
| J9351-HCPCS | Low | Injection, topotecan, 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 J9351. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J9351 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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