How much does Medicare pay for HCPCS J0185?

Medicare allowed an average of $1.68 per service and paid $1.33 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $7.00, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code J0185?

Injection, aprepitant, 1 mg. It was billed 7,828,538 times to 21,217 Medicare beneficiaries by 826 providers in 2024.

Which specialty bills J0185 most?

Hematology-Oncology, with 5,770,743 services from 588 clinicians. Next are Medical Oncology, Internal Medicine, Hematology.

HCPCS J0185

Injection, aprepitant, 1 mg

$1.68Medicare-allowed amount per service, averaged across 7,828,538 services

Providers submitted

$7.00

Asking price, not received

Medicare allowed

$1.68

The fee schedule figure

Medicare paid

$1.33

Balance is patient coinsurance

Providers submitted an average of $7.00 for this code and Medicare allowed $1.68 — 4.2× 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 $1.33 (79%); the rest is the patient’s coinsurance and deductible.

Services: 7,828,538
Beneficiaries: 21,217
Providers billing it: 826
Total allowed: $13,151,944

What Medicare pays for HCPCS J0185

Across 7,828,538 services billed by 826 providers to 21,217 beneficiaries, Medicare allowed an average of $1.68 per service. That is 369.0 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 J0185

Specialty	Services	Beneficiaries	Avg allowed	Providers
Hematology-Oncology	5,770,743	15,586	$1.68	588
Medical Oncology	1,348,499	3,533	$1.68	153
Internal Medicine	310,326	914	$1.68	32
Hematology	149,890	364	$1.68	11
Gynecological Oncology	126,750	387	$1.68	17
Nurse Practitioner	69,940	237	$1.68	15
Physician Assistant	31,460	122	$1.68	6
Hospitalist	14,040	37	$1.70	1
Obstetrics & Gynecology	2,730	14	$1.71	1
Hematopoietic Cell Transplantation and Cellular Therapy	2,340	12	$1.71	1
Radiation Oncology	1,820	11	$1.69	1

J0185 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.

State	Services	Allowed	Standardized pmt	Providers
Florida	1,493,168	$1.67	$1.34	158
California	759,999	$1.69	$1.34	77
Virginia	510,640	$1.68	$1.35	58
Kansas	409,110	$1.69	$1.35	12
Maryland	349,571	$1.67	$1.35	41
Illinois	273,130	$1.68	$1.34	36
Arkansas	262,600	$1.68	$1.34	24
Minnesota	260,260	$1.69	$1.34	28
South Carolina	257,660	$1.68	$1.35	20
New Jersey	250,530	$1.68	$1.35	28
Georgia	243,638	$1.68	$1.35	25
Arizona	226,200	$1.69	$1.35	27
Mississippi	177,840	$1.65	$1.35	8
Oregon	173,160	$1.68	$1.35	28
Iowa	168,490	$1.69	$1.34	12
North Carolina	164,840	$1.67	$1.35	19
Indiana	164,710	$1.66	$1.35	14
Utah	155,615	$1.68	$1.34	16
Alabama	152,490	$1.68	$1.34	17
Missouri	137,020	$1.69	$1.34	13
Ohio	132,340	$1.68	$1.35	15
Tennessee	131,950	$1.69	$1.35	10
Washington	130,780	$1.68	$1.34	20
New York	120,641	$1.67	$1.34	13
Colorado	110,760	$1.67	$1.35	23
Nebraska	104,780	$1.69	$1.35	8
New Mexico	78,130	$1.68	$1.35	14
Nevada	73,580	$1.68	$1.36	14
Oklahoma	58,500	$1.67	$1.33	12
Wyoming	51,740	$1.68	$1.34	3
Texas	51,090	$1.69	$1.35	7
Louisiana	49,270	$1.69	$1.35	5
Michigan	45,766	$1.69	$1.35	5
Pennsylvania	36,530	$1.67	$1.35	6
Connecticut	17,030	$1.69	$1.35	2
Vermont	16,900	$1.69	$1.34	1
Hawaii	9,880	$1.71	$1.36	2
New Hampshire	6,240	$1.68	$1.34	2
Rhode Island	4,680	$1.69	$1.35	1
Massachusetts	3,770	$1.68	$1.34	1
Idaho	3,510	$1.70	$1.36	1

Related codes

J0174Injection, lecanemab-irmb, 1 mg$1.30
J0129Injection, abatacept, 10 mg (code may be used for medicare when drug a$42.28
J0178Injection, aflibercept, 1 mg$822.26
J0177Injection, aflibercept hd, 1 mg$329.49
J0153Injection, adenosine, 1 mg (not to be used to report any adenosine pho$0.50
J0175Injection, donanemab-azbt, 2 mg$4.03
J0131Injection, acetaminophen, not otherwise specified,10 mg$0.05
J0179Injection, brolucizumab-dbll, 1 mg$322.73
J0171Injection, adrenalin, epinephrine, 0.1 mg$0.78

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.