RxDoctor Payments Data

HCPCS J7312

Injection, dexamethasone, intravitreal implant, 0.1 mg

$199.53Medicare-allowed amount per service, averaged across 122,136 services
Providers submitted
$364.34

Asking price, not received

Medicare allowed
$199.53

The fee schedule figure

Medicare paid
$158.38

Balance is patient coinsurance

Providers submitted an average of $364.34 for this code and Medicare allowed $199.531.8× 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 $158.38 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility
$199.52
Hospital / facility
$202.32

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 121,888 services were billed in an office setting and 248 in a facility.

Services
122,136

Medicare Part B, 2024

Beneficiaries
7,967
Providers billing it
436
Total allowed
$24,369,796

Services × allowed amount

What Medicare pays for HCPCS J7312

Across 122,136 services billed by 436 providers to 7,967 beneficiaries, Medicare allowed an average of $199.53 per service. That is 15.3 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 J7312

SpecialtyServicesBeneficiariesAvg allowedProviders
Ophthalmology121,8887,925$199.52434
Ambulatory Surgical Center24842$202.322

J7312 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
California10,435$200.27$159.7744
Florida8,703$201.00$160.2729
Texas8,264$197.92$161.2537
Maryland7,429$200.28$161.0521
Arizona6,317$200.63$161.3420
Illinois5,825$200.10$160.9117
North Carolina5,061$201.12$160.4915
Virginia4,753$198.70$160.9418
Ohio4,734$193.61$155.2920
New York4,531$200.70$160.5415
Washington3,857$201.70$160.3314
Kentucky3,724$197.48$161.8814
Pennsylvania3,423$201.68$161.1312
New Jersey3,157$198.65$161.3112
Tennessee3,122$197.49$161.5211
Alabama2,989$192.59$159.737
Kansas2,926$201.01$160.1811
Georgia2,912$201.85$159.5413
Colorado2,723$201.87$159.7910
Missouri2,373$201.42$160.2910
Nevada2,283$201.07$161.096
Utah2,107$199.84$161.737
Michigan2,044$197.10$162.119
Indiana1,583$201.44$159.336
South Carolina1,540$199.85$161.465
Mississippi1,540$196.84$162.178
Idaho1,526$202.34$159.713
Montana1,393$199.28$160.593
Arkansas1,337$202.31$160.894
Oregon1,268$197.73$162.254
Oklahoma1,232$194.54$162.763
Iowa1,183$195.33$161.735
New Mexico1,169$197.48$161.974
Louisiana714$200.34$160.902
North Dakota693$202.31$160.771
Massachusetts644$202.31$160.983
Connecticut630$200.16$159.783
Alaska357$202.30$161.061
Wisconsin336$202.39$157.292
District of Columbia315$202.30$161.191
Guam238$193.72$162.471
Hawaii203$196.37$162.691
Rhode Island161$202.31$161.191
West Virginia154$202.31$160.801
South Dakota140$188.16$164.171
Minnesota88$202.44$154.211

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.