How much does Medicare pay for HCPCS J1580?

Medicare allowed an average of $2.48 per service and paid $1.91 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $16.35, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code J1580?

Injection, garamycin, gentamicin, up to 80 mg. It was billed 55,422 times to 29,570 Medicare beneficiaries by 943 providers in 2024.

Does J1580 pay differently in an office than a hospital?

Yes. The allowed amount averaged $2.48 in an office setting and $2.49 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills J1580 most?

Urology, with 43,374 services from 743 clinicians. Next are Nurse Practitioner, Family Practice, Physician Assistant.

HCPCS J1580

Injection, garamycin, gentamicin, up to 80 mg

$2.48Medicare-allowed amount per service, averaged across 55,422 services

Providers submitted

$16.35

Asking price, not received

Medicare allowed

$2.48

The fee schedule figure

Medicare paid

$1.91

Balance is patient coinsurance

Providers submitted an average of $16.35 for this code and Medicare allowed $2.48 — 6.6× 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 $1.91 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $2.48
Hospital / facility: $2.49

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 54,844 services were billed in an office setting and 577 in a facility.

Services: 55,422
Beneficiaries: 29,570
Providers billing it: 943
Total allowed: $137,447

What Medicare pays for HCPCS J1580

Across 55,422 services billed by 943 providers to 29,570 beneficiaries, Medicare allowed an average of $2.48 per service. That is 1.9 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 J1580

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	43,374	24,306	$2.48	743
Nurse Practitioner	5,635	2,330	$2.49	83
Family Practice	2,604	1,319	$2.41	50
Physician Assistant	1,036	492	$2.49	22
Internal Medicine	818	303	$2.38	15
Obstetrics & Gynecology	816	181	$2.48	10
General Practice	377	140	$2.49	4
Diagnostic Radiology	250	170	$2.46	2
Podiatry	144	125	$2.53	3
Radiation Oncology	136	87	$2.45	3
Infectious Disease	80	11	$2.59	1
Emergency Medicine	72	47	$2.37	3
Otolaryngology	28	13	$2.54	1
Interventional Radiology	22	20	$2.45	1
Orthopedic Surgery	16	12	$2.52	1

J1580 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	8,257	$2.51	$1.95	114
California	7,360	$2.48	$1.96	106
Texas	5,258	$2.47	$1.93	96
New Jersey	3,775	$2.48	$1.96	52
Tennessee	3,037	$2.46	$1.86	50
Mississippi	2,723	$2.42	$1.83	39
New York	2,387	$2.49	$1.95	42
Colorado	1,754	$2.51	$1.94	12
Arizona	1,723	$2.50	$2.00	31
Alabama	1,622	$2.37	$1.71	36
North Carolina	1,423	$2.49	$1.90	40
Pennsylvania	1,407	$2.47	$1.97	21
Maryland	1,208	$2.47	$1.94	9
Virginia	1,108	$2.50	$1.95	22
Michigan	1,085	$2.49	$1.98	28
Oklahoma	951	$2.48	$1.93	25
Massachusetts	854	$2.49	$1.99	18
Missouri	810	$2.47	$1.91	25
Kansas	804	$2.52	$2.00	12
Ohio	757	$2.46	$1.90	17
Indiana	737	$2.49	$1.98	14
Illinois	609	$2.52	$1.94	11
Washington	557	$2.48	$1.86	13
Georgia	549	$2.48	$1.94	14
Louisiana	504	$2.50	$1.82	7
South Carolina	426	$2.50	$1.91	11
Connecticut	388	$2.40	$1.94	6
Oregon	383	$2.44	$1.89	7
Minnesota	339	$2.50	$2.02	4
Kentucky	325	$2.48	$1.94	5
Delaware	324	$2.49	$1.98	5
Arkansas	283	$2.48	$1.92	8
Nevada	222	$2.54	$2.00	4
Alaska	218	$2.41	$1.94	5
Idaho	214	$2.45	$1.99	6
Utah	204	$2.48	$1.92	5
District of Columbia	163	$2.47	$1.93	4
Wisconsin	129	$2.52	$1.93	6
New Mexico	105	$2.51	$2.00	3
Montana	101	$2.38	$1.99	1
New Hampshire	65	$2.52	$2.03	1
Wyoming	64	$2.56	$1.92	1
Guam	53	$2.47	$1.96	1
Maine	39	$2.54	$2.03	1
U.S. Virgin Islands	38	$2.37	$1.89	2
West Virginia	30	$1.97	$1.47	1
Puerto Rico	25	$2.24	$1.78	1
Iowa	24	$2.61	$2.08	1

Related codes

J1569Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g.$44.58
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

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.