RxDoctor Payments Data

HCPCS J3245

Injection, tildrakizumab, 1 mg

$134.63Medicare-allowed amount per service, averaged across 1,278,409 services
Providers submitted
$326.85

Asking price, not received

Medicare allowed
$134.63

The fee schedule figure

Medicare paid
$107.14

Balance is patient coinsurance

Providers submitted an average of $326.85 for this code and Medicare allowed $134.632.4× 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 $107.14 (80%); the rest is the patient’s coinsurance and deductible.

Services
1,278,409

Medicare Part B, 2024

Beneficiaries
5,255
Providers billing it
265
Total allowed
$172,112,204

Services × allowed amount

What Medicare pays for HCPCS J3245

Across 1,278,409 services billed by 265 providers to 5,255 beneficiaries, Medicare allowed an average of $134.63 per service. That is 243.3 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 J3245

SpecialtyServicesBeneficiariesAvg allowedProviders
Nurse Practitioner605,7002,910$134.67147
Dermatology372,9051,233$134.9164
Rheumatology77,000274$134.8018
Physician Assistant61,400207$133.2212
Family Practice56,200269$135.599
Infectious Disease27,40091$134.143
Internal Medicine20,50066$134.573
Vascular Surgery18,10068$129.101
Hematology-Oncology12,60049$135.244
Gastroenterology8,80034$134.031
Anesthesiology6,50020$134.681
Obstetrics & Gynecology5,70016$134.851
Neurology5,60418$135.141

J3245 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.

StateServicesAllowedStandardized pmtProviders
Texas143,301$134.78$107.2537
South Carolina99,800$134.68$107.2121
California95,700$135.20$107.5815
Florida93,200$135.22$107.6420
Pennsylvania91,700$133.30$106.0814
Illinois65,700$134.33$107.2513
Tennessee65,200$134.10$106.7316
New Jersey53,500$135.10$107.5611
North Carolina48,800$134.96$107.4212
Ohio47,503$133.43$106.449
Indiana38,400$134.83$107.299
Missouri31,400$134.96$107.438
Virginia31,300$134.76$107.254
Kentucky30,301$134.79$107.236
Massachusetts28,004$135.34$107.754
Arkansas26,500$133.57$107.836
Georgia25,200$134.89$107.365
Iowa24,600$134.80$107.264
Wisconsin24,500$134.71$107.255
Arizona22,900$135.56$107.866
New York20,100$134.05$106.625
Oklahoma19,000$134.33$106.933
Maryland17,300$135.25$107.623
Delaware15,700$135.14$107.502
Colorado14,300$135.03$107.433
Connecticut13,000$133.09$105.932
Michigan12,500$134.32$107.863
Alabama11,700$134.45$107.073
Nebraska10,700$135.55$107.831
Kansas10,000$134.88$107.303
North Dakota9,900$134.86$107.322
Mississippi6,900$135.12$107.492
South Dakota6,500$134.85$107.211
Nevada5,800$132.56$105.571
New Hampshire5,800$138.07$109.842
Oregon3,800$135.71$107.891
Hawaii3,600$132.57$108.751
Washington2,600$134.05$106.691
New Mexico1,700$134.66$106.961

Related codes

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.