How much does Medicare pay for HCPCS J1245?

Medicare allowed an average of $3.64 per service and paid $2.89 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $29.61, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code J1245?

Injection, dipyridamole, per 10 mg. It was billed 24,663 times to 4,846 Medicare beneficiaries by 93 providers in 2024.

Which specialty bills J1245 most?

Cardiology, with 17,167 services from 71 clinicians. Next are Independent Diagnostic Testing Facility (IDTF), Interventional Cardiology, Internal Medicine.

HCPCS J1245

Injection, dipyridamole, per 10 mg

$3.64Medicare-allowed amount per service, averaged across 24,663 services

Providers submitted

$29.61

Asking price, not received

Medicare allowed

$3.64

The fee schedule figure

Medicare paid

$2.89

Balance is patient coinsurance

Providers submitted an average of $29.61 for this code and Medicare allowed $3.64 — 8.1× 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 $2.89 (79%); the rest is the patient’s coinsurance and deductible.

Services: 24,663
Beneficiaries: 4,846
Providers billing it: 93
Total allowed: $89,773

What Medicare pays for HCPCS J1245

Across 24,663 services billed by 93 providers to 4,846 beneficiaries, Medicare allowed an average of $3.64 per service. That is 5.1 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 J1245

Specialty	Services	Beneficiaries	Avg allowed	Providers
Cardiology	17,167	3,362	$3.69	71
Independent Diagnostic Testing Facility (IDTF)	2,829	580	$3.34	4
Interventional Cardiology	2,228	373	$3.68	6
Internal Medicine	843	167	$3.67	6
Nuclear Medicine	628	152	$3.36	2
Clinical Cardiac Electrophysiology	556	120	$3.73	1
General Practice	170	35	$3.72	1
Cardiac Surgery	156	39	$3.66	1
Peripheral Vascular Disease	86	18	$3.71	1

J1245 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	6,972	$3.69	$2.94	30
Texas	4,974	$3.49	$2.81	7
New York	1,960	$3.69	$2.93	8
Michigan	1,623	$3.72	$2.96	7
New Jersey	1,592	$3.70	$2.94	8
Maryland	1,479	$3.74	$2.99	5
Kentucky	1,160	$3.66	$2.93	1
Pennsylvania	1,002	$3.70	$2.92	9
Tennessee	941	$3.66	$2.94	4
Delaware	877	$3.65	$2.91	4
Louisiana	591	$3.72	$2.97	1
Mississippi	464	$3.58	$2.93	1
Alabama	309	$3.69	$2.94	2
West Virginia	292	$3.67	$2.93	2
Massachusetts	164	$3.74	$2.98	1
Wisconsin	128	$3.75	$2.99	1
Puerto Rico	70	$0.68	$0.54	1
North Carolina	65	$2.95	$2.35	1

Related codes

J1200Injection, diphenhydramine hcl, up to 50 mg$0.80
J1201Injection, cetirizine hydrochloride, 0.5 mg$14.55
J1250Injection, dobutamine hydrochloride, per 250 mg$8.45

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.