How much does Medicare pay for HCPCS J7345?

Medicare allowed an average of $1.66 per service and paid $1.31 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $3.42, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code J7345?

Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg. It was billed 7,885,670 times to 26,287 Medicare beneficiaries by 815 providers in 2024.

Which specialty bills J7345 most?

Dermatology, with 5,625,275 services from 540 clinicians. Next are Physician Assistant, Nurse Practitioner, Micrographic Dermatologic Surgery.

HCPCS J7345

Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg

$1.66Medicare-allowed amount per service, averaged across 7,885,670 services

Providers submitted

$3.42

Asking price, not received

Medicare allowed

$1.66

The fee schedule figure

Medicare paid

$1.31

Balance is patient coinsurance

Providers submitted an average of $3.42 for this code and Medicare allowed $1.66 — 2.1× 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 $1.31 (79%); the rest is the patient’s coinsurance and deductible.

Services: 7,885,670
Beneficiaries: 26,287
Providers billing it: 815
Total allowed: $13,090,212

What Medicare pays for HCPCS J7345

Across 7,885,670 services billed by 815 providers to 26,287 beneficiaries, Medicare allowed an average of $1.66 per service. That is 300.0 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 J7345

Specialty	Services	Beneficiaries	Avg allowed	Providers
Dermatology	5,625,275	18,570	$1.66	540
Physician Assistant	1,310,557	4,508	$1.67	176
Nurse Practitioner	693,913	2,464	$1.67	77
Micrographic Dermatologic Surgery	148,101	397	$1.66	10
Family Practice	45,400	163	$1.67	6
Internal Medicine	40,001	111	$1.66	3
General Practice	13,023	45	$1.66	1
Pathology	5,400	16	$1.64	1
Critical Care (Intensivists)	4,000	13	$1.68	1

J7345 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	1,005,254	$1.66	$1.31	102
Texas	719,606	$1.66	$1.32	77
New York	697,350	$1.66	$1.33	56
Florida	617,787	$1.66	$1.32	69
Arizona	611,200	$1.66	$1.32	35
Pennsylvania	401,405	$1.66	$1.32	38
Georgia	249,802	$1.66	$1.31	26
Ohio	241,106	$1.66	$1.33	27
Colorado	231,000	$1.67	$1.31	32
Missouri	222,001	$1.67	$1.32	22
Utah	211,214	$1.67	$1.30	25
Illinois	207,822	$1.66	$1.28	29
Nevada	175,600	$1.67	$1.30	7
South Carolina	169,202	$1.66	$1.32	12
New Jersey	168,925	$1.65	$1.31	19
North Carolina	164,201	$1.66	$1.29	17
Virginia	148,225	$1.66	$1.30	14
Massachusetts	146,901	$1.63	$1.30	19
Kentucky	143,804	$1.65	$1.30	18
Washington	131,200	$1.67	$1.31	15
Tennessee	120,920	$1.67	$1.28	15
Delaware	113,400	$1.67	$1.33	5
Maryland	107,211	$1.66	$1.30	11
Indiana	103,903	$1.66	$1.33	15
Mississippi	103,401	$1.66	$1.31	11
Arkansas	84,001	$1.65	$1.33	11
Louisiana	76,601	$1.66	$1.32	8
Oregon	71,401	$1.65	$1.30	14
Idaho	67,201	$1.67	$1.33	7
Michigan	56,000	$1.66	$1.33	6
Minnesota	54,001	$1.67	$1.33	8
Connecticut	51,801	$1.67	$1.32	8
Kansas	31,400	$1.68	$1.27	4
Wyoming	30,401	$1.67	$1.33	4
Montana	29,400	$1.67	$1.29	4
Iowa	24,000	$1.68	$1.33	4
Wisconsin	23,523	$1.65	$1.30	6
Alabama	22,900	$1.68	$1.30	4
New Hampshire	20,600	$1.68	$1.32	4
West Virginia	14,400	$1.65	$1.24	3
New Mexico	7,200	$1.66	$1.29	2
District of Columbia	6,000	$1.68	$1.34	1
Hawaii	2,400	$1.69	$1.34	1

Related codes

J7328Hyaluronan or derivative$0.52
J7318Hyaluronan or derivative$6.47
J7320Hyaluronan or derivitive$5.37
J7325Hyaluronan or derivative$8.81
J7336Capsaicin 8% patch$3.25
J7329Hyaluronan or derivative$7.16
J7322Hyaluronan or derivative$17.14
J7332Hyaluronan or derivative$10.15
J7331Hyaluronan or derivative$10.27
J7321Hyaluronan or derivative$72.31
J7323Hyaluronan or derivative$118.58
J7324Hyaluronan or derivative$123.96

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.