Wiki Finding Reimbursement Rates for codes?

[AmyNAtkins87]

We are going to venture into a new type of injection and I cannot find the reimbursement rate for the codes, which in then would let us know what we should set our price at for billing to insurance. Specifically looking for J7323 and J7325. I thought I found something online while researching, but than the clinic we're speaking with said what they bill and it's way different! Plus they're in Minnesota and I'm in Washington State.... Please help!

 

[CodingKing]

Medicare Drug Fee Schedule for example. Its the same rate nationally. Asking another clinic wont tell you much as everyone uses a different markup

https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/2020-asp-drug-pricing-files

Payment Allowance Limits for Medicare Part B Drugs
Effective January 1, 2020 through March 31, 2020
Note 1: Payment allowance limits subject to the ASP methodology are based on 3Q19 ASP data.
Note 2: The absence or presence of a HCPCS code and the payment allowance limits in this table does not indicate whether Medicare covers a drug. These determinations shall be made by the local Medicare contractor processing the claim.
HCPCS Code	Short Description	HCPCS Code Dosage	Payment Limit	Vaccine AWP%	Vaccine Limit	Blood AWP%	Blood limit	Clotting Factor	Notes
J7323	Euflexxa inj per dose	per dose	144.694
J7325	Synvisc or synvisc-one	1 MG	11.025