How much does Medicare pay for HCPCS J2778?

Medicare allowed an average of $159.00 per service and paid $125.48 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $600.94, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code J2778?

Injection, ranibizumab, 0.1 mg. It was billed 689,609 times to 31,895 Medicare beneficiaries by 753 providers in 2024.

Does J2778 pay differently in an office than a hospital?

Yes. The allowed amount averaged $159.00 in an office setting and $159.48 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 J2778 most?

Ophthalmology, with 688,103 services from 751 clinicians. Next are Ambulatory Surgical Center.

HCPCS J2778

Injection, ranibizumab, 0.1 mg

$159.00Medicare-allowed amount per service, averaged across 689,609 services

Providers submitted

$600.94

Asking price, not received

Medicare allowed

$159.00

The fee schedule figure

Medicare paid

$125.48

Balance is patient coinsurance

Providers submitted an average of $600.94 for this code and Medicare allowed $159.00 — 3.8× 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 $125.48 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $159.00
Hospital / facility: $159.48

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 688,103 services were billed in an office setting and 1,506 in a facility.

Services: 689,609
Beneficiaries: 31,895
Providers billing it: 753
Total allowed: $109,647,831

What Medicare pays for HCPCS J2778

Across 689,609 services billed by 753 providers to 31,895 beneficiaries, Medicare allowed an average of $159.00 per service. That is 21.6 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 J2778

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	688,103	31,846	$159.00	751
Ambulatory Surgical Center	1,506	49	$159.48	2

J2778 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	119,888	$156.64	$124.92	62
Florida	80,930	$160.13	$126.92	73
California	61,991	$159.24	$126.40	96
Mississippi	60,268	$160.15	$128.16	10
Michigan	40,150	$156.72	$125.18	33
Pennsylvania	33,776	$158.99	$125.98	34
North Carolina	19,793	$161.37	$127.69	30
South Carolina	19,558	$160.84	$127.92	21
New York	18,846	$159.63	$125.68	38
Maryland	18,744	$158.20	$125.21	18
Georgia	17,761	$160.38	$124.33	22
Iowa	16,626	$156.07	$122.60	15
New Jersey	16,532	$158.94	$126.96	20
Kansas	15,269	$161.55	$126.57	15
Massachusetts	14,717	$158.58	$125.82	20
Illinois	12,692	$157.78	$124.03	17
Arizona	9,450	$160.27	$127.61	19
New Mexico	8,458	$157.61	$125.50	8
Virginia	8,227	$162.16	$127.29	18
Louisiana	7,990	$158.90	$123.78	8
Colorado	7,800	$164.47	$127.93	14
Utah	7,001	$159.06	$125.57	5
Indiana	6,351	$155.50	$123.87	8
Tennessee	5,830	$159.95	$128.56	21
Missouri	5,817	$163.89	$128.84	18
Washington	5,300	$160.06	$127.01	12
Kentucky	5,196	$158.84	$126.20	9
Oregon	4,763	$158.01	$124.41	11
Maine	4,012	$160.27	$124.52	7
Nebraska	3,677	$157.97	$125.13	9
Connecticut	3,586	$159.67	$125.35	8
Delaware	3,404	$157.74	$122.92	2
Wisconsin	2,911	$159.10	$127.17	4
Idaho	2,857	$167.76	$128.22	4
Oklahoma	2,577	$158.82	$126.94	4
Arkansas	2,516	$161.91	$127.99	7
Minnesota	2,426	$156.84	$124.62	6
Wyoming	1,850	$161.05	$128.31	1
South Dakota	1,774	$157.88	$124.89	4
Nevada	1,772	$167.31	$130.26	4
Ohio	1,509	$163.83	$127.42	7
Montana	1,155	$152.59	$124.89	1
North Dakota	755	$161.52	$128.35	2
West Virginia	736	$159.54	$126.89	2
New Hampshire	728	$162.78	$127.02	1
Alabama	655	$156.56	$123.85	1
Rhode Island	398	$166.74	$127.98	2
Vermont	337	$160.20	$127.00	1
Hawaii	250	$154.29	$126.14	1

Related codes

J2777Injection, faricimab-svoa, 0.1 mg$34.37
J2781Injection, pegcetacoplan, intravitreal, 1 mg$146.64
J2785Injection, regadenoson, 0.1 mg$6.76
J2782Injection, avacincaptad pegol, 0.1 mg$108.28
J2704Injection, propofol, 10 mg$0.11
J2795Injection, ropivacaine hydrochloride, 1 mg$0.07
J2796Injection, romiplostim, 10 micrograms$96.86
J2720Injection, protamine sulfate, per 10 mg$1.54

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.