How much does Medicare pay for HCPCS J2997?

Medicare allowed an average of $88.19 per service and paid $69.79 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $248.70, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code J2997?

Injection, alteplase recombinant, 1 mg. It was billed 11,482 times to 3,215 Medicare beneficiaries by 147 providers in 2024.

Does J2997 pay differently in an office than a hospital?

Yes. The allowed amount averaged $87.96 in an office setting and $88.52 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 J2997 most?

Ambulatory Surgical Center, with 4,596 services from 40 clinicians. Next are Hematology-Oncology, Medical Oncology, Interventional Radiology.

HCPCS J2997

Injection, alteplase recombinant, 1 mg

$88.19Medicare-allowed amount per service, averaged across 11,482 services

Providers submitted

$248.70

Asking price, not received

Medicare allowed

$88.19

The fee schedule figure

Medicare paid

$69.79

Balance is patient coinsurance

Providers submitted an average of $248.70 for this code and Medicare allowed $88.19 — 2.8× 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 $69.79 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $87.96
Hospital / facility: $88.52

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 6,886 services were billed in an office setting and 4,596 in a facility.

Services: 11,482
Beneficiaries: 3,215
Providers billing it: 147
Total allowed: $1,012,598

What Medicare pays for HCPCS J2997

Across 11,482 services billed by 147 providers to 3,215 beneficiaries, Medicare allowed an average of $88.19 per service. That is 3.6 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 J2997

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	4,596	1,304	$88.52	40
Hematology-Oncology	1,844	661	$87.72	45
Medical Oncology	1,358	177	$88.12	9
Interventional Radiology	1,331	351	$87.69	17
Nephrology	1,106	340	$88.20	16
Diagnostic Radiology	513	132	$88.65	5
Vascular Surgery	327	132	$87.26	7
Hematology	159	42	$88.63	3
Internal Medicine	140	39	$88.28	2
Nurse Practitioner	52	14	$88.33	1
Infectious Disease	32	11	$88.58	1
Interventional Cardiology	24	12	$89.05	1

J2997 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	3,728	$88.41	$69.91	28
Texas	908	$88.19	$70.62	12
Pennsylvania	705	$88.64	$69.73	6
Georgia	687	$87.11	$70.00	11
Virginia	575	$88.68	$70.53	5
North Carolina	516	$88.42	$70.45	4
Arizona	496	$88.51	$70.12	7
New York	482	$88.33	$70.10	8
Florida	480	$88.64	$70.65	11
Maryland	343	$87.28	$69.48	4
New Jersey	283	$88.59	$70.58	3
Illinois	279	$88.69	$70.66	3
Kansas	242	$87.42	$70.24	5
Iowa	216	$86.21	$69.83	5
Mississippi	170	$88.59	$70.66	3
Arkansas	156	$85.67	$68.93	4
Wisconsin	124	$88.93	$70.85	2
Missouri	90	$88.72	$68.58	2
Rhode Island	90	$88.57	$70.61	1
Guam	85	$84.68	$66.56	2
Connecticut	80	$88.29	$70.35	1
South Dakota	74	$89.06	$70.96	1
Nebraska	68	$88.77	$70.73	2
Alaska	68	$81.43	$69.22	2
Massachusetts	64	$88.51	$70.52	1
District of Columbia	58	$88.74	$70.71	1
Nevada	56	$88.64	$70.63	2
Tennessee	52	$88.26	$70.47	1
Michigan	42	$87.89	$67.63	1
Minnesota	36	$88.92	$68.16	1
Colorado	32	$88.89	$70.82	1
Oklahoma	32	$88.58	$70.58	1
Washington	32	$88.37	$70.40	1
South Carolina	30	$88.65	$70.63	1
Wyoming	28	$88.74	$70.70	1
Ohio	26	$88.63	$70.62	1
Utah	25	$88.84	$70.79	1
Maine	24	$88.71	$70.68	1

Related codes

J2919Injection, methylprednisolone sodium succinate, 5 mg$0.28
J2916Injection, sodium ferric gluconate complex in sucrose injection, 12.5$2.14
J2930Injection, methylprednisolone sodium succinate, up to 125 mg$5.71
J2920Injection, methylprednisolone sodium succinate, up to 40 mg$4.09

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.