HCPCS J9355 (Herceptin) 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 | $75.025  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J9355 by major payers:
$86.50
$85.35
$88.80
$83.79
| 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 J9355 | ||||||
United | J9355 | $82.44 | 1407928500 - THE GOOD SAMARITAN HOSPITAL OF LEBANON, PENNSYLVANIA, WELLSPAN GOOD SAMARITAN HOSPITAL ACUTE CARE HOSPITAL | 232730785 - WELLSPAN MEDICAL GROUP | PA | General Acute Care Hospital (282N00000X) |
United | J9355 | $67.11 | 1427007384 - ASCENSION SE WISCONSIN HOSPITAL, INC, ASCENSION SE WISCONSIN HOSPITAL-ST JOSEPH CAMPUS | 350868157 - SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS INC | WI | General Acute Care Hospital (282N00000X) |
United | J9355 | $77.05 | 1548217763 - FLUSHING HOSPITAL & MEDICAL CENTER | 111631781 - FLUSHING HOSPITAL & MEDICAL CENTER | NY | General Acute Care Hospital (282N00000X) |
United | J9355 | $77.88 | 1972503910 - WACCAMAW COMMUNITY HOSPITAL, TIDELANDS WACCAMAW COMMUNITY HOSPITAL | 43633263 - WACCAMAW COMMUNITY HOSPITAL | SC | General Acute Care Hospital (282N00000X) |
United | J9355 | $83.08 | 1598008658 - EISENHOWER MEDICAL CENTER, EISENHOWER | 956130458 - EISENHOWER MEDICAL CENTER | CA | General Acute Care Hospital (282N00000X) |
United | J9355 | $69.34 | 1477579464 - NASSAU HEALTH CARE CORPORATION, NUMC DEPARTMENT OF RADIOLOGY, FFP | 113465690 | NY | General Acute Care Hospital (282N00000X) |
United | J9355 | $77.94 | 1720434806 - THEDACARE REGIONAL MEDICAL CENTER, THEDA CLARK MEDICAL CENTER, INC. | 390830664 - (WI) THEDACARE REGIONAL MEDICAL CENTER - NEENAH INC | WI | General Acute Care Hospital (282N00000X) |
United | J9355 | $77.05 | 1477818607 - BINSAH GEORGE | 760459500 - U T PHYSICIANS | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9355 | $77.05 | 1265546048 - FREEMAN-OAK HILL HEALTH SYSTEM, FREEMAN HEALTH SYSTEM | 431240629 - (MO) FREEMAN NEOSHO HOSPITAL | MO | General Acute Care Hospital (282N00000X) |
United | J9355 | $39.75 | 1457619017 - DIMITRY HIKIN | 132813103 - OPEN DOOR FAMILY MEDICAL CENTER INC | NY | General Acute Care Hospital (282N00000X) |
United | J9355 | $85.76 | 1598272338 - KARE INFUSION CENTER LLC | 823564415 - (TX) KARE INFUSION CENTER LLC | TX | Infusion Therapy Clinic/Center (261QI0500X) |
United | J9355 | $86.91 | 1275971533 - CORSICANA CANCER CENTER | 462901238 - (TX) CORSICANA CANCER CENTER | TX | Radiation Oncology Physician (2085R0001X) |
United | J9355 | $75.79 | 1447678768 - EUGENE OSWALD | 853991596 | NJ | General Acute Care Hospital (282N00000X) |
United | J9355 | $87.09 | 1861883589 - CARILION FRANKLIN MEMORIAL HOSPITAL | 540506332 - CARILION MEDICAL CENTER | VA | General Acute Care Hospital (282N00000X) |
United | J9355 | $77.05 | 1538111653 - NYU LUTHERAN MEDICAL CENTER | 111839567 - (NY) NYU LANGONE HOSPITALS | NY | General Acute Care Hospital (282N00000X) |
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 J9355 vs. Other Chemotherapy Drugs Codes
The HCPCS J9355 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 J9355 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 |
|---|---|---|
| J9354-HCPCS | Low | Injection, ado-trastuzumab emtansine, 1 mg |
| J9355-HCPCS | Low | Injection, trastuzumab, excludes biosimilar, 10 mg |
| J9356-HCPCS | Low | Injection, trastuzumab, 10 mg and Hyaluronidase-oysk |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J9355. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J9355 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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