How much does Medicare pay for HCPCS J9155?

Medicare allowed an average of $4.16 per service and paid $3.26 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $9.60, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code J9155?

Injection, degarelix, 1 mg. It was billed 707,305 times to 2,366 Medicare beneficiaries by 128 providers in 2024.

Which specialty bills J9155 most?

Urology, with 484,424 services from 89 clinicians. Next are Nurse Practitioner, Physician Assistant, Hematology-Oncology.

HCPCS J9155

Injection, degarelix, 1 mg

$4.16Medicare-allowed amount per service, averaged across 707,305 services

Providers submitted

$9.60

Asking price, not received

Medicare allowed

$4.16

The fee schedule figure

Medicare paid

$3.26

Balance is patient coinsurance

Providers submitted an average of $9.60 for this code and Medicare allowed $4.16 — 2.3× 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 $3.26 (78%); the rest is the patient’s coinsurance and deductible.

Services: 707,305
Beneficiaries: 2,366
Providers billing it: 128
Total allowed: $2,942,389

What Medicare pays for HCPCS J9155

Across 707,305 services billed by 128 providers to 2,366 beneficiaries, Medicare allowed an average of $4.16 per service. That is 298.9 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 J9155

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	484,424	1,559	$4.16	89
Nurse Practitioner	100,040	377	$4.16	17
Physician Assistant	84,961	317	$4.13	14
Hematology-Oncology	25,880	69	$4.18	5
Medical Oncology	7,120	25	$4.08	2
Radiation Oncology	4,880	19	$4.07	1

J9155 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
Florida	100,443	$4.17	$3.28	16
Maryland	87,280	$4.16	$3.29	13
South Carolina	48,560	$4.14	$3.28	6
New Jersey	47,920	$4.19	$3.30	6
Nevada	40,883	$4.12	$3.31	5
Virginia	38,480	$4.17	$3.28	10
New York	38,080	$4.18	$3.26	6
California	31,360	$4.17	$3.27	6
Nebraska	25,360	$4.18	$3.30	3
Illinois	22,175	$4.15	$3.29	4
Indiana	20,480	$4.14	$3.29	4
Texas	19,440	$4.10	$3.30	3
Arkansas	18,920	$4.18	$3.10	5
Michigan	16,640	$4.06	$3.35	4
Alaska	14,881	$4.18	$3.33	1
Colorado	14,000	$4.13	$3.29	5
Pennsylvania	13,240	$4.18	$3.33	4
Tennessee	13,200	$4.19	$3.24	4
Mississippi	11,200	$4.13	$3.32	2
Massachusetts	10,720	$4.07	$3.33	2
Missouri	10,680	$4.09	$3.33	1
North Carolina	9,840	$4.16	$3.30	2
Connecticut	7,922	$4.18	$3.29	2
Arizona	5,280	$4.18	$3.29	2
Georgia	5,040	$4.17	$3.32	2
Wyoming	4,480	$4.19	$3.32	1
New Mexico	4,240	$4.16	$3.31	1
South Dakota	4,160	$4.20	$3.28	1
Ohio	4,080	$4.20	$3.35	1
New Hampshire	3,760	$4.15	$3.25	1
Minnesota	3,360	$4.17	$3.27	1
Oklahoma	3,121	$4.18	$3.32	1
Iowa	2,960	$4.18	$3.32	1
Kentucky	2,640	$4.15	$3.27	1
Delaware	2,480	$4.19	$3.27	1

Related codes

J9144Injection, daratumumab, 10 mg and hyaluronidase-fihj$48.93
J9190Injection, fluorouracil, 500 mg$2.88
J9171Injection, docetaxel, 1 mg$0.86
J9119Injection, cemiplimab-rwlc, 1 mg$27.25
J9177Injection, enfortumab vedotin-ejfv, 0.25 mg$35.42
J9173Injection, durvalumab, 10 mg$79.13
J9181Injection, etoposide, 10 mg$1.10
J9196Injection, gemcitabine hydrochloride (accord), not therapeutically equ$7.02

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.