How much does Medicare pay for HCPCS J0717?

Medicare allowed an average of $4.54 per service and paid $3.60 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $13.91, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Which specialty bills J0717 most?

Rheumatology, with 54,064,815 services from 782 clinicians. Next are Internal Medicine, Nurse Practitioner, Physician Assistant.

HCPCS J0717

Injection, certolizumab pegol, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)

$4.54Medicare-allowed amount per service, averaged across 61,165,045 services

Providers submitted

$13.91

Asking price, not received

Medicare allowed

$4.54

The fee schedule figure

Medicare paid

$3.60

Balance is patient coinsurance

Providers submitted an average of $13.91 for this code and Medicare allowed $4.54 — 3.1× 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 $3.60 (79%); the rest is the patient’s coinsurance and deductible.

Services: 61,165,045
Beneficiaries: 26,374
Providers billing it: 958
Total allowed: $277,689,304

What Medicare pays for HCPCS J0717

Across 61,165,045 services billed by 958 providers to 26,374 beneficiaries, Medicare allowed an average of $4.54 per service. That is 2319.1 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 J0717

Specialty	Services	Beneficiaries	Avg allowed	Providers
Rheumatology	54,064,815	22,222	$4.54	782
Internal Medicine	2,912,681	1,241	$4.54	49
Nurse Practitioner	2,473,866	1,719	$4.54	76
Physician Assistant	782,260	768	$4.54	30
Allergy/ Immunology	290,400	101	$4.56	3
Hospitalist	252,623	90	$4.55	3
Infectious Disease	155,400	61	$4.52	2
Family Practice	64,800	70	$4.55	6
Pharmacy	41,400	21	$4.50	1
Gastroenterology	39,200	16	$4.57	1
Hematology-Oncology	36,400	23	$4.60	2
Certified Clinical Nurse Specialist	25,200	14	$4.58	1
Vascular Surgery	19,600	13	$4.51	1
General Practice	6,400	15	$4.66	1

J0717 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	10,204,133	$4.55	$3.62	136
Texas	6,807,418	$4.53	$3.62	102
California	4,156,552	$4.51	$3.58	54
Pennsylvania	4,081,553	$4.55	$3.61	78
New Jersey	3,741,271	$4.54	$3.62	69
Virginia	2,889,400	$4.55	$3.62	34
Illinois	2,782,338	$4.55	$3.62	38
Kentucky	2,116,800	$4.51	$3.62	31
North Carolina	1,920,805	$4.54	$3.61	47
South Carolina	1,729,400	$4.54	$3.62	21
Maryland	1,590,600	$4.53	$3.62	25
Tennessee	1,500,956	$4.54	$3.62	22
Arizona	1,358,401	$4.56	$3.62	23
New York	1,265,240	$4.56	$3.62	24
Delaware	1,164,240	$4.53	$3.62	10
Georgia	1,072,463	$4.53	$3.62	17
Ohio	1,042,801	$4.54	$3.61	13
Utah	1,001,602	$4.56	$3.62	11
Arkansas	946,260	$4.55	$3.61	14
Missouri	894,802	$4.54	$3.62	13
Alabama	859,401	$4.55	$3.62	11
Indiana	785,601	$4.53	$3.61	18
Louisiana	648,801	$4.55	$3.61	9
Kansas	573,001	$4.55	$3.61	12
Colorado	554,663	$4.53	$3.60	16
Oklahoma	531,600	$4.53	$3.62	10
Nebraska	515,800	$4.54	$3.63	5
Iowa	441,000	$4.55	$3.61	18
Mississippi	428,001	$4.55	$3.61	11
Massachusetts	364,818	$4.56	$3.62	7
District of Columbia	359,000	$4.50	$3.62	2
Nevada	351,249	$4.52	$3.62	5
Michigan	349,001	$4.55	$3.61	7
Connecticut	347,800	$4.56	$3.62	9
New Mexico	342,200	$4.51	$3.62	5
Washington	244,465	$4.48	$3.58	7
Idaho	211,200	$4.54	$3.61	4
Hawaii	187,600	$4.51	$3.62	1
Rhode Island	153,600	$4.55	$3.62	2
South Dakota	142,009	$4.55	$3.61	3
Oregon	132,000	$4.55	$3.60	3
Wisconsin	97,200	$4.57	$3.62	2
Montana	81,400	$4.56	$3.61	2
West Virginia	75,200	$4.55	$3.61	1
Maine	64,000	$4.56	$3.60	1
Minnesota	40,000	$4.53	$3.60	4
Puerto Rico	17,400	$4.63	$3.66	1

Related codes

J0702Injection, betamethasone acetate 3 mg and betamethasone sodium phospha$6.91
J0775Injection, collagenase, clostridium histolyticum, 0.01 mg$67.07
J0713Injection, ceftazidime, per 500 mg$1.63
J0735Injection, clonidine hydrochloride, 1 mg$17.39

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.