How much does Medicare pay for HCPCS J1459?

Medicare allowed an average of $47.48 per service and paid $37.79 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $123.46, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code J1459?

Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg. It was billed 500,244 times to 867 Medicare beneficiaries by 52 providers in 2024.

Which specialty bills J1459 most?

Neurology, with 273,062 services from 5 clinicians. Next are Rheumatology, Hematology-Oncology, Infectious Disease.

HCPCS J1459

Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg

$47.48Medicare-allowed amount per service, averaged across 500,244 services

Providers submitted

$123.46

Asking price, not received

Medicare allowed

$47.48

The fee schedule figure

Medicare paid

$37.79

Balance is patient coinsurance

Providers submitted an average of $123.46 for this code and Medicare allowed $47.48 — 2.6× 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 $37.79 (80%); the rest is the patient’s coinsurance and deductible.

Services: 500,244
Beneficiaries: 867
Providers billing it: 52
Total allowed: $23,751,585

What Medicare pays for HCPCS J1459

Across 500,244 services billed by 52 providers to 867 beneficiaries, Medicare allowed an average of $47.48 per service. That is 577.0 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 J1459

Specialty	Services	Beneficiaries	Avg allowed	Providers
Neurology	273,062	135	$47.58	5
Rheumatology	64,483	211	$47.52	12
Hematology-Oncology	61,690	231	$47.44	14
Infectious Disease	28,310	50	$47.60	3
Medical Oncology	23,380	82	$46.50	6
Nurse Practitioner	16,880	46	$47.58	4
Allergy/ Immunology	11,602	24	$47.66	2
Internal Medicine	9,710	29	$47.59	2
Family Practice	6,100	13	$47.52	1
Hematopoietic Cell Transplantation and Cellular Therapy	4,230	15	$45.77	1
Surgical Oncology	710	11	$47.82	1
General Practice	87	20	$0.01	1

J1459 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
California	231,483	$47.56	$37.88	12
Texas	66,720	$47.63	$37.95	2
Alabama	48,800	$46.90	$38.00	11
North Carolina	34,282	$47.49	$37.75	4
Pennsylvania	30,950	$47.51	$37.87	9
Georgia	26,330	$47.57	$37.81	3
Mississippi	18,080	$47.56	$37.85	1
Louisiana	15,730	$47.61	$37.89	2
New Jersey	9,710	$47.42	$37.72	1
Oklahoma	5,672	$47.62	$37.79	1
Connecticut	5,240	$47.56	$37.86	1
Virginia	3,940	$46.65	$38.15	1
Nebraska	2,510	$47.35	$37.25	2
Minnesota	710	$47.82	$38.10	1
Tennessee	87	$0.01	$0.01	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
J1454Injection, fosnetupitant 235 mg and palonosetron 0.25 mg$676.41

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.