How much does Medicare pay for HCPCS J1454?

Medicare allowed an average of $676.41 per service and paid $538.73 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1628.29, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code J1454?

Injection, fosnetupitant 235 mg and palonosetron 0.25 mg. It was billed 25,883 times to 9,773 Medicare beneficiaries by 448 providers in 2024.

Which specialty bills J1454 most?

Hematology-Oncology, with 17,006 services from 305 clinicians. Next are Medical Oncology, Internal Medicine, Hematology.

HCPCS J1454

Injection, fosnetupitant 235 mg and palonosetron 0.25 mg

$676.41Medicare-allowed amount per service, averaged across 25,883 services

Providers submitted

$1628.29

Asking price, not received

Medicare allowed

$676.41

The fee schedule figure

Medicare paid

$538.73

Balance is patient coinsurance

Providers submitted an average of $1628.29 for this code and Medicare allowed $676.41 — 2.4× 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 $538.73 (80%); the rest is the patient’s coinsurance and deductible.

Services: 25,883
Beneficiaries: 9,773
Providers billing it: 448
Total allowed: $17,507,520

What Medicare pays for HCPCS J1454

Across 25,883 services billed by 448 providers to 9,773 beneficiaries, Medicare allowed an average of $676.41 per service. That is 2.6 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 J1454

Specialty	Services	Beneficiaries	Avg allowed	Providers
Hematology-Oncology	17,006	6,587	$675.57	305
Medical Oncology	6,854	2,364	$678.10	103
Internal Medicine	951	390	$679.08	18
Hematology	431	167	$672.46	9
Gynecological Oncology	197	68	$676.04	3
Hospitalist	141	60	$683.49	2
Nurse Practitioner	135	52	$680.52	2
Physician Assistant	89	44	$679.71	3
Radiation Oncology	66	29	$680.32	2
Rheumatology	13	12	$677.53	1

J1454 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
Texas	5,117	$679.31	$541.49	95
Tennessee	4,210	$673.38	$541.17	69
New York	2,311	$677.68	$537.50	42
Alabama	2,142	$680.11	$539.02	28
Virginia	2,098	$677.05	$541.74	51
Georgia	1,633	$664.93	$533.35	21
New Jersey	1,301	$672.33	$534.68	22
Illinois	995	$679.59	$540.38	14
Kansas	794	$683.49	$542.21	9
Delaware	752	$677.73	$540.77	8
California	718	$669.87	$542.49	13
Michigan	528	$678.96	$539.71	11
Maryland	498	$673.50	$537.10	15
Maine	396	$676.91	$541.17	7
Florida	302	$681.77	$541.19	5
North Carolina	276	$680.46	$542.20	6
Ohio	276	$680.45	$540.60	2
South Carolina	238	$679.20	$539.27	6
Nebraska	200	$684.87	$542.21	3
Pennsylvania	164	$672.99	$541.90	5
Idaho	157	$668.54	$541.14	3
Missouri	149	$682.06	$541.20	2
New Hampshire	136	$678.13	$543.02	2
Alaska	129	$663.40	$547.80	3
Mississippi	110	$681.22	$540.23	2
North Dakota	90	$674.77	$542.75	1
South Dakota	79	$680.82	$540.67	1
Oklahoma	59	$679.01	$546.02	1
Connecticut	25	$676.11	$537.51	1

Related codes

J1439Injection, ferric carboxymaltose, 1 mg$1.09
J1453Injection, fosaprepitant, 1 mg$0.14
J1437Injection, ferric derisomaltose, 10 mg$19.81
J1449Injection, eflapegrastim-xnst, 0.1 mg$26.09
J1434Injection, fosaprepitant (focinvez), 1 mg$2.91
J1442Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram$0.97
J1459Injection, immune globulin (privigen), intravenous, non-lyophilized (e$47.48

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.