HCPCS J9356 (Herceptin Hylecta) 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 |
| Complexity Level | Low |
| Medicare Payment Limit | $61.436  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
| Related NDC Codes | • 50242-0077-01 - HERCEPTIN HYLECTA (PF) 10000 U/5 ML-600 MG/5 ML |
National average reimbursement for HCPCS J9356 by major payers:
$70.43
$69.29
$72.48
$68.01
| 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 J9356 | ||||||
United | J9356 | $66.83 | 1003192311 - EL CAMPO MEMORIAL HOSPITAL | 452750258 - (TX) EL CAMPO MEMORIAL HOSPITAL | TX | General Acute Care Hospital (282N00000X) |
United | J9356 | $86.41 | 1003870759 - VIVIAN CLINE | 752131429 - US ONCOLOGY CORPORATE, INC. | TX | Medical Oncology Physician (207RX0202X) |
United | J9356 | $63.06 | 1215219522 - JIU KIM | 756002868 - ABKSW PREFERRED HEALTH PARTNERS PLLC / ACTION FAMILY CARE PLLC / ADAM S MINER MD PA | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9356 | $75.66 | 1013250455 - JEREMY ROSS | 752512142 - (TX) ONCOLOGYHEMATOLOGY CONSULTANTS PA | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9356 | $63.06 | 1932384450 - BILAL OMER | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Pediatric Hematology & Oncology Physician (2080P0207X) |
United | J9356 | $86.41 | 1861401788 - NAROTHAM THUDI | 752131429 - US ONCOLOGY CORPORATE, INC. | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9356 | $84.50 | 1932359866 - PURNIMA SRAVANTI TEEGAVARAPU | 741613878 - (TX) BAYLOR COLLEGE OF MEDICINE | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9356 | $64.94 | 1790944023 - DANIEL GOMEZ | 320577172 - (NY) MSK RALPH LAUREN CENTER | TX | Radiation Oncology Physician (2085R0001X) |
United | J9356 | $66.83 | 1427755040 - PRINCETON MEDICAL ASSOCIATES PLLC | 922253595 - (TX) PRINCETON MEDICAL ASSOCIATES PLLC | TX | Rheumatology Physician (207RR0500X) |
United | J9356 | $63.06 | 1386952950 - GHADIR SASA | 262400924 - (TX) CARDIOLOGY CLINIC OF SAN ANTONIO PLLC / CHILDRENS CRITICAL CARE SPECIALISTS PLLC / EDWARD E HORVATH DO PA | TX | Pediatric Hematology & Oncology Physician (2080P0207X) |
United | J9356 | $63.06 | 1275538985 - ROBERT DRODER | 752931720 - ETMC PHYSICIAN GROUP INC / EVMS ACADEMIC PHYSICIANS AND SURGEONS HEALTH SERVICES FOUNDATION / UNIVERSITY OF TEXAS HEALTH CENTER AT TYLER | TX | Hematology & Oncology Physician (207RH0003X) |
United | J9356 | $63.06 | 1659353795 - DAVID JONES | 451525991 - (TX) CLEAR SPRINGS CENTER FOR CANCER CARE LTD | TX | Radiation Oncology Physician (2085R0001X) |
United | J9356 | $64.94 | 1790944023 - DANIEL GOMEZ | 611791803 - (NJ) MEMORIAL SLOAN KETTERING CANCER CENTER AT BASKING RIDGE NEW JERSEY / MSK BERGEN / WOODHULL MEDICAL AND MENTAL HEALTH CENTER | TX | Radiation Oncology Physician (2085R0001X) |
United | J9356 | $67.62 | 1700037801 - PROVIDENCE HEALTH & SERVICES-WA | 320261234 | WA | General Acute Care Hospital (282N00000X) |
United | J9356 | $70.19 | 1295821577 - RANDALL JOHNSON | 834717842 - (TX) RHEUMATOLOGY OF THE WOODLANDS PLLC | TX | Rheumatology Physician (207RR0500X) |
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 J9356 vs. Other Chemotherapy Drugs Codes
The HCPCS J9356 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 J9356 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 |
|---|---|---|
| 50242-0077-01-NDC | Moderate | HERCEPTIN HYLECTA (PF) 10000 U/5 ML-600 MG/5 ML |
| J9355-HCPCS | Low | Injection, trastuzumab, excludes biosimilar, 10 mg |
| J9356-HCPCS | Low | Injection, trastuzumab, 10 mg and Hyaluronidase-oysk |
| J9357-HCPCS | High | Injection, valrubicin, intravesical, 200 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J9356. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J9356 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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