How much does Medicare pay for HCPCS J1568?

Medicare allowed an average of $45.73 per service and paid $36.39 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $182.11, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code J1568?

Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg. It was billed 1,950,771 times to 8,003 Medicare beneficiaries by 447 providers in 2024.

Which specialty bills J1568 most?

Hematology-Oncology, with 1,130,600 services from 277 clinicians. Next are Medical Oncology, Neurology, Nurse Practitioner.

HCPCS J1568

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

$45.73Medicare-allowed amount per service, averaged across 1,950,771 services

Providers submitted

$182.11

Asking price, not received

Medicare allowed

$45.73

The fee schedule figure

Medicare paid

$36.39

Balance is patient coinsurance

Providers submitted an average of $182.11 for this code and Medicare allowed $45.73 — 4.0× 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 $36.39 (80%); the rest is the patient’s coinsurance and deductible.

Services: 1,950,771
Beneficiaries: 8,003
Providers billing it: 447
Total allowed: $89,208,758

What Medicare pays for HCPCS J1568

Across 1,950,771 services billed by 447 providers to 8,003 beneficiaries, Medicare allowed an average of $45.73 per service. That is 243.8 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 J1568

Specialty	Services	Beneficiaries	Avg allowed	Providers
Hematology-Oncology	1,130,600	4,927	$45.96	277
Medical Oncology	329,960	1,651	$45.25	91
Neurology	211,662	309	$45.09	15
Nurse Practitioner	68,340	220	$46.16	14
Internal Medicine	64,546	393	$45.52	22
Hematology	45,554	138	$45.39	8
Physician Assistant	19,890	120	$46.47	6
Allergy/ Immunology	18,250	68	$46.13	4
Infectious Disease	17,338	30	$45.16	2
Hospitalist	11,890	26	$46.79	2
Rheumatology	10,171	22	$45.53	1
Pediatric Medicine	10,000	37	$46.50	1
Family Practice	5,030	14	$46.07	1
Hematopoietic Cell Transplantation and Cellular Therapy	4,950	25	$46.16	1
Gynecological Oncology	1,430	12	$46.28	1

J1568 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	292,360	$46.06	$36.98	85
Alabama	275,684	$45.57	$36.82	30
Colorado	138,937	$46.24	$36.91	39
New York	120,250	$46.19	$37.11	30
Virginia	108,516	$46.16	$37.04	39
Nevada	105,972	$44.49	$37.43	16
New Jersey	98,914	$45.78	$37.30	6
California	96,371	$46.54	$37.08	20
Tennessee	89,443	$45.60	$36.63	14
Mississippi	81,758	$45.01	$37.26	8
Maryland	54,614	$46.04	$36.94	16
Pennsylvania	51,306	$46.52	$37.17	18
Kansas	45,305	$46.37	$36.88	11
Illinois	45,200	$46.04	$37.15	13
Florida	42,574	$46.18	$36.79	16
Minnesota	41,536	$45.97	$37.14	12
Arizona	33,106	$46.41	$36.95	14
Ohio	32,370	$34.91	$28.01	7
Delaware	29,130	$45.73	$37.21	4
Washington	28,710	$46.22	$36.95	9
Missouri	19,390	$46.48	$36.92	7
South Carolina	18,960	$45.68	$37.04	4
Indiana	18,500	$45.09	$37.53	4
Iowa	16,580	$47.56	$37.89	4
Michigan	12,330	$46.44	$36.93	3
North Dakota	11,220	$46.50	$37.05	2
North Carolina	8,820	$46.27	$36.87	4
Louisiana	6,600	$46.21	$37.08	1
Oregon	5,437	$46.42	$36.89	2
Massachusetts	4,850	$46.72	$37.36	2
Idaho	3,760	$45.91	$37.33	1
Nebraska	3,540	$47.42	$37.78	2
Connecticut	2,956	$45.98	$36.51	1
Wyoming	2,662	$45.88	$36.42	1
Vermont	2,110	$47.61	$37.94	1
South Dakota	1,000	$47.05	$37.48	1

Related codes

J1569Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g.$44.58
J1561Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g$48.15
J1556Injection, immune globulin (bivigam), 500 mg$72.82
J1576Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.$66.24
J1580Injection, garamycin, gentamicin, up to 80 mg$2.48

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.