How much does Medicare pay for HCPCS J3590?

Medicare allowed an average of $583.31 per service and paid $462.51 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1430.04, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code J3590?

Unclassified biologics. It was billed 155,553 times to 42,766 Medicare beneficiaries by 734 providers in 2024.

Which specialty bills J3590 most?

Ophthalmology, with 114,352 services from 708 clinicians. Next are Rheumatology, Dermatology, Allergy/ Immunology.

HCPCS J3590

Unclassified biologics

$583.31Medicare-allowed amount per service, averaged across 155,553 services

Providers submitted

$1430.04

Asking price, not received

Medicare allowed

$583.31

The fee schedule figure

Medicare paid

$462.51

Balance is patient coinsurance

Providers submitted an average of $1430.04 for this code and Medicare allowed $583.31 — 2.5× 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 $462.51 (79%); the rest is the patient’s coinsurance and deductible.

Services: 155,553
Beneficiaries: 42,766
Providers billing it: 734
Total allowed: $90,735,620

What Medicare pays for HCPCS J3590

Across 155,553 services billed by 734 providers to 42,766 beneficiaries, Medicare allowed an average of $583.31 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.

Who bills J3590

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	114,352	42,367	$772.41	708
Rheumatology	36,916	192	$59.28	12
Dermatology	3,119	120	$0.02	8
Allergy/ Immunology	546	23	$0.00	2
Pulmonary Disease	321	12	$0.00	1
Internal Medicine	256	34	$465.49	2
Nurse Practitioner	42	18	$2385.43	1

J3590 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
Washington	34,525	$11.30	$9.00	4
Ohio	28,458	$335.17	$264.68	99
Michigan	15,145	$158.16	$124.27	77
Indiana	14,777	$86.38	$66.38	49
Kentucky	8,662	$153.30	$120.60	38
Iowa	5,964	$121.90	$94.32	26
Nebraska	4,776	$89.64	$69.08	13
Pennsylvania	4,716	$1810.47	$1439.90	42
Missouri	4,056	$526.72	$417.89	27
Texas	3,879	$2438.24	$1940.13	39
Kansas	3,827	$274.88	$213.87	20
Maryland	3,533	$3069.27	$2449.73	29
New Jersey	3,250	$2779.31	$2216.49	30
California	2,819	$467.90	$371.95	23
Virginia	1,714	$3103.24	$2478.39	17
Florida	1,650	$1321.68	$1050.79	19
Illinois	1,644	$1302.10	$1029.85	24
Louisiana	1,555	$671.54	$532.01	6
New York	1,449	$1998.81	$1591.50	22
North Carolina	1,301	$3135.41	$2510.81	18
Nevada	1,120	$644.46	$509.59	4
Arizona	1,018	$1348.57	$1073.01	14
Colorado	718	$2541.74	$2019.34	12
Tennessee	630	$726.88	$577.79	5
New Mexico	549	$1846.35	$1463.74	8
Minnesota	533	$2277.57	$1811.68	10
Massachusetts	482	$2626.33	$2086.74	8
Connecticut	445	$2473.60	$2011.40	8
South Carolina	397	$2358.21	$1893.97	5
Utah	352	$2505.23	$2003.43	5
New Hampshire	296	$2633.09	$2097.24	3
South Dakota	265	$2581.08	$2048.99	3
Georgia	174	$2660.64	$2112.50	3
Mississippi	167	$2677.13	$2122.59	4
Arkansas	135	$2313.10	$1837.42	5
Wisconsin	100	$64.09	$46.76	1
District of Columbia	88	$2690.78	$2142.02	2
Oregon	88	$1665.03	$1315.38	2
North Dakota	61	$2621.85	$2079.76	2
Puerto Rico	53	$2258.96	$1797.93	1
Hawaii	46	$3238.86	$2580.55	1
Oklahoma	45	$2358.02	$1867.17	2
Montana	26	$2251.96	$1755.43	1
Delaware	24	$2634.82	$2091.25	1
Alabama	23	$2660.69	$2109.96	1
Alaska	17	$1661.26	$1323.60	1

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.