RxDoctor Payments Data

HCPCS J0177

Injection, aflibercept hd, 1 mg

$329.49Medicare-allowed amount per service, averaged across 1,820,837 services
Providers submitted
$717.41

Asking price, not received

Medicare allowed
$329.49

The fee schedule figure

Medicare paid
$262.53

Balance is patient coinsurance

Providers submitted an average of $717.41 for this code and Medicare allowed $329.492.2× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $262.53 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility
$329.49
Hospital / facility
$330.87

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 1,819,045 services were billed in an office setting and 1,792 in a facility.

Services
1,820,837

Medicare Part B, 2024

Beneficiaries
65,417
Providers billing it
1,392
Total allowed
$599,947,583

Services × allowed amount

What Medicare pays for HCPCS J0177

Across 1,820,837 services billed by 1,392 providers to 65,417 beneficiaries, Medicare allowed an average of $329.49 per service. That is 27.8 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

This is a drug or supply code rather than a service. The unit is usually a dose or a milligram, so the per-service figure is small by construction and the total is what carries meaning — read it alongside the service count rather than on its own.

Who bills J0177

SpecialtyServicesBeneficiariesAvg allowedProviders
Ophthalmology1,818,54165,296$329.491,389
Ambulatory Surgical Center1,79293$330.871
Gastroenterology35216$332.001
Physician Assistant15212$334.721

J0177 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

StateServicesAllowedStandardized pmtProviders
Texas146,805$329.57$263.48108
Maryland144,625$329.24$264.3654
Florida139,004$328.76$262.72130
Ohio117,059$329.84$263.2761
New Jersey109,284$330.59$263.9954
New York105,671$329.59$263.2288
California104,818$329.59$263.16113
Virginia95,474$329.22$263.2656
Pennsylvania75,699$329.91$263.3072
North Carolina69,517$329.79$264.0753
Illinois52,013$328.85$262.3854
South Carolina46,794$330.59$263.8719
Washington42,722$328.26$262.0431
Indiana42,494$328.13$262.8728
Colorado39,356$331.07$264.2629
Georgia38,185$328.83$263.1033
Utah37,950$329.12$263.7215
Massachusetts35,883$329.51$263.6631
Michigan30,737$330.07$263.7441
Missouri29,393$330.24$263.9622
Tennessee29,102$328.11$264.6928
Kansas28,961$330.97$264.0310
Minnesota25,364$331.04$264.4116
Kentucky25,066$330.29$264.1519
Connecticut20,137$329.56$263.8520
Arizona16,727$330.35$263.1921
Oregon16,188$325.80$259.5819
Nevada13,380$331.04$264.3017
New Mexico12,405$331.63$264.449
Oklahoma12,189$328.27$263.0214
Louisiana10,580$329.79$263.008
Idaho10,544$329.48$262.899
Wisconsin10,410$327.48$262.7012
New Hampshire10,153$330.43$263.805
South Dakota9,154$330.61$264.427
West Virginia8,672$325.03$265.007
Montana7,466$329.69$263.296
Iowa6,424$330.70$263.4810
Nebraska6,295$330.52$263.348
Arkansas6,196$330.51$264.139
Mississippi6,090$331.56$264.176
Alabama4,673$329.56$262.5710
Hawaii4,296$329.73$264.224
District of Columbia3,624$331.02$263.743
North Dakota2,616$320.55$258.175
Maine2,235$323.10$264.424
Rhode Island1,936$323.20$265.804
Delaware1,360$307.95$269.113
Puerto Rico1,072$332.82$265.171
Vermont1,072$331.42$264.061
Alaska1,000$325.12$264.372
Wyoming984$331.11$263.811
Guam984$303.07$269.672

Related codes

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.