How much does Medicare pay for HCPCS J2781?

Medicare allowed an average of $146.64 per service and paid $116.63 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $298.74, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code J2781?

Injection, pegcetacoplan, intravitreal, 1 mg. It was billed 2,452,956 times to 28,892 Medicare beneficiaries by 857 providers in 2024.

Does J2781 pay differently in an office than a hospital?

Yes. The allowed amount averaged $146.64 in an office setting and $146.72 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 J2781 most?

Ophthalmology, with 2,443,146 services from 852 clinicians. Next are Ambulatory Surgical Center, Nurse Practitioner, Pediatric Medicine.

HCPCS J2781

Injection, pegcetacoplan, intravitreal, 1 mg

$146.64Medicare-allowed amount per service, averaged across 2,452,956 services

Providers submitted

$298.74

Asking price, not received

Medicare allowed

$146.64

The fee schedule figure

Medicare paid

$116.63

Balance is patient coinsurance

Providers submitted an average of $298.74 for this code and Medicare allowed $146.64 — 2.0× 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 $116.63 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $146.64
Hospital / facility: $146.72

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 2,444,841 services were billed in an office setting and 8,115 in a facility.

Services: 2,452,956
Beneficiaries: 28,892
Providers billing it: 857
Total allowed: $359,701,468

What Medicare pays for HCPCS J2781

Across 2,452,956 services billed by 857 providers to 28,892 beneficiaries, Medicare allowed an average of $146.64 per service. That is 84.9 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 J2781

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	2,443,146	28,766	$146.64	852
Ambulatory Surgical Center	5,910	69	$146.75	3
Nurse Practitioner	2,505	34	$146.42	1
Pediatric Medicine	1,395	23	$146.61	1

J2781 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	255,165	$146.72	$116.77	86
Florida	215,097	$146.68	$116.88	76
Texas	212,480	$146.93	$117.00	65
Maryland	191,417	$146.73	$116.84	29
New York	133,074	$146.44	$116.80	57
Ohio	120,202	$146.37	$117.06	37
Pennsylvania	113,619	$146.69	$116.94	44
New Jersey	92,619	$146.72	$116.94	37
Washington	88,158	$146.73	$116.89	30
Utah	86,681	$146.74	$116.93	20
South Carolina	83,128	$146.62	$116.99	21
Virginia	80,182	$146.41	$116.73	32
Tennessee	78,577	$146.79	$117.02	30
Colorado	69,050	$146.40	$117.01	25
Illinois	53,070	$146.87	$116.76	26
Indiana	50,594	$146.68	$116.85	15
Oregon	37,312	$146.91	$116.69	13
Arizona	36,802	$147.02	$117.04	21
Idaho	32,206	$146.36	$116.63	7
North Carolina	31,652	$146.54	$116.55	14
Louisiana	30,394	$146.26	$116.60	14
Connecticut	30,272	$147.03	$116.79	14
Michigan	29,075	$146.23	$116.72	16
Missouri	26,895	$146.62	$117.20	9
South Dakota	26,057	$146.91	$117.04	6
Massachusetts	25,442	$146.12	$117.15	11
Georgia	25,225	$146.19	$116.20	16
Mississippi	23,130	$146.88	$116.94	7
Nebraska	20,072	$146.94	$116.85	7
Kansas	19,095	$146.79	$116.52	6
Alabama	17,215	$146.32	$116.45	5
Minnesota	13,712	$145.63	$117.06	5
Oklahoma	13,171	$145.63	$116.91	6
Kentucky	13,161	$146.89	$116.89	6
Maine	11,911	$144.87	$117.04	4
Arkansas	9,930	$147.21	$116.86	7
Iowa	8,761	$146.61	$116.59	7
New Mexico	7,383	$145.41	$117.20	4
North Dakota	7,020	$146.72	$116.82	3
Wyoming	6,510	$146.52	$116.74	1
Wisconsin	6,423	$146.59	$116.60	4
Nevada	6,420	$147.27	$117.24	4
Delaware	4,485	$145.61	$117.45	3
West Virginia	3,375	$146.97	$116.75	1
Montana	2,851	$146.82	$116.30	2
Alaska	1,606	$146.69	$116.87	2
Rhode Island	1,290	$147.02	$117.08	1
Hawaii	990	$124.44	$99.15	1

Related codes

J2777Injection, faricimab-svoa, 0.1 mg$34.37
J2785Injection, regadenoson, 0.1 mg$6.76
J2782Injection, avacincaptad pegol, 0.1 mg$108.28
J2704Injection, propofol, 10 mg$0.11
J2778Injection, ranibizumab, 0.1 mg$159.00
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.