RxDoctor Payments Data

HCPCS J7351

Injection, bimatoprost, intracameral implant, 1 microgram

$203.27Medicare-allowed amount per service, averaged across 56,428 services
Providers submitted
$296.09

Asking price, not received

Medicare allowed
$203.27

The fee schedule figure

Medicare paid
$161.75

Balance is patient coinsurance

Providers submitted an average of $296.09 for this code and Medicare allowed $203.271.5× 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 $161.75 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility
$202.87
Hospital / facility
$204.07

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 37,405 services were billed in an office setting and 19,023 in a facility.

Services
56,428

Medicare Part B, 2024

Beneficiaries
3,423
Providers billing it
147
Total allowed
$11,470,120

Services × allowed amount

What Medicare pays for HCPCS J7351

Across 56,428 services billed by 147 providers to 3,423 beneficiaries, Medicare allowed an average of $203.27 per service. That is 16.5 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 J7351

SpecialtyServicesBeneficiariesAvg allowedProviders
Ophthalmology37,4052,260$202.87108
Ambulatory Surgical Center19,0231,163$204.0739

J7351 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
California13,694$204.28$162.6622
Florida8,329$201.53$161.5422
Texas3,792$204.31$162.4011
Massachusetts3,538$203.86$162.0310
Virginia2,440$202.60$162.507
Arizona2,280$203.63$162.738
Pennsylvania2,169$203.41$163.076
Alabama2,052$204.28$161.794
New York2,022$203.39$161.935
Georgia1,662$203.61$162.165
Maryland1,351$204.53$162.584
Missouri1,142$203.84$162.433
Illinois1,113$194.92$158.805
South Carolina1,110$204.37$162.513
New Jersey1,001$203.82$161.783
Connecticut990$204.87$163.232
Mississippi930$204.09$162.402
Tennessee892$204.41$162.793
North Carolina770$204.25$162.742
Oregon670$201.32$160.361
Utah492$202.31$163.861
Ohio490$201.98$164.222
Nebraska470$199.25$164.482
Michigan450$200.85$163.692
Colorado410$204.08$161.662
District of Columbia351$194.18$164.971
Arkansas270$203.17$163.171
Montana240$204.21$161.231
Louisiana240$202.99$161.731
Wisconsin220$205.19$163.481
South Dakota220$203.95$162.261
Rhode Island210$204.51$162.941
Wyoming161$205.72$163.911
Minnesota160$204.48$162.591
Maine97$204.63$163.021

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.