How much does Medicare pay for HCPCS J1569?

Medicare allowed an average of $44.58 per service and paid $35.47 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $127.86, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code J1569?

Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg. It was billed 2,848,101 times to 11,226 Medicare beneficiaries by 593 providers in 2024.

Which specialty bills J1569 most?

Hematology-Oncology, with 1,380,867 services from 328 clinicians. Next are Medical Oncology, Nurse Practitioner, Neurology.

HCPCS J1569

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

$44.58Medicare-allowed amount per service, averaged across 2,848,101 services

Providers submitted

$127.86

Asking price, not received

Medicare allowed

$44.58

The fee schedule figure

Medicare paid

$35.47

Balance is patient coinsurance

Providers submitted an average of $127.86 for this code and Medicare allowed $44.58 — 2.9× 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 $35.47 (80%); the rest is the patient’s coinsurance and deductible.

Services: 2,848,101
Beneficiaries: 11,226
Providers billing it: 593
Total allowed: $126,968,343

What Medicare pays for HCPCS J1569

Across 2,848,101 services billed by 593 providers to 11,226 beneficiaries, Medicare allowed an average of $44.58 per service. That is 253.7 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 J1569

Specialty	Services	Beneficiaries	Avg allowed	Providers
Hematology-Oncology	1,380,867	6,398	$44.58	328
Medical Oncology	418,647	1,641	$44.58	85
Nurse Practitioner	361,081	993	$44.57	59
Neurology	223,524	257	$44.49	14
Rheumatology	102,868	366	$44.41	22
Internal Medicine	68,310	303	$44.55	12
Infectious Disease	65,172	181	$44.72	12
Hematology	60,980	543	$45.46	31
Pharmacy	43,190	38	$44.11	1
Physician Assistant	36,707	158	$44.61	10
Allergy/ Immunology	35,948	151	$44.19	8
Family Practice	29,931	84	$44.35	5
Anesthesiology	14,866	14	$45.39	1
Hematopoietic Cell Transplantation and Cellular Therapy	6,010	99	$45.48	5

J1569 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	733,214	$44.62	$35.57	139
California	257,542	$44.48	$35.39	34
Illinois	212,383	$44.61	$35.74	48
Texas	186,709	$44.68	$35.56	11
South Carolina	131,176	$44.72	$35.64	26
Ohio	114,506	$44.79	$35.76	18
Arizona	105,215	$44.90	$35.66	47
Virginia	100,519	$44.66	$35.69	25
Tennessee	100,120	$44.14	$35.53	22
Minnesota	99,690	$44.64	$35.53	38
Michigan	90,970	$44.59	$35.63	17
Nebraska	75,501	$44.82	$35.79	10
New Jersey	67,663	$44.69	$35.64	16
Missouri	60,627	$44.46	$35.73	12
Oklahoma	58,376	$44.36	$35.58	20
Pennsylvania	48,290	$44.03	$35.71	7
Maryland	45,793	$44.29	$35.25	9
Arkansas	43,703	$44.43	$35.48	11
Alabama	41,361	$44.41	$35.50	12
North Carolina	38,390	$44.42	$35.34	12
Iowa	34,761	$43.92	$35.15	10
Maine	34,100	$44.86	$35.71	8
Georgia	30,868	$44.63	$35.63	5
Kansas	24,520	$44.46	$35.29	6
New York	24,140	$43.71	$34.77	7
Connecticut	15,810	$45.22	$35.97	3
Colorado	14,866	$45.39	$36.15	1
Indiana	13,080	$44.03	$35.19	4
Washington	10,526	$45.33	$36.10	5
Idaho	8,910	$45.37	$36.10	1
Wisconsin	6,998	$42.68	$35.69	3
New Hampshire	5,250	$44.67	$35.58	2
Mississippi	4,920	$44.52	$35.47	1
Louisiana	3,368	$43.75	$34.60	1
Nevada	2,860	$44.64	$35.49	1
Utah	1,376	$44.91	$35.64	1

Related codes

J1568Injection, immune globulin, (octagam), intravenous, non-lyophilized (e$45.73
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.