How much does Medicare pay for HCPCS J9190?

Medicare allowed an average of $2.88 per service and paid $2.28 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $18.97, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code J9190?

Injection, fluorouracil, 500 mg. It was billed 600,546 times to 27,545 Medicare beneficiaries by 1,467 providers in 2024.

Does J9190 pay differently in an office than a hospital?

Yes. The allowed amount averaged $2.88 in an office setting and $0.01 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills J9190 most?

Hematology-Oncology, with 425,666 services from 779 clinicians. Next are Medical Oncology, Internal Medicine, Hematology.

HCPCS J9190

Injection, fluorouracil, 500 mg

$2.88Medicare-allowed amount per service, averaged across 600,546 services

Providers submitted

$18.97

Asking price, not received

Medicare allowed

$2.88

The fee schedule figure

Medicare paid

$2.28

Balance is patient coinsurance

Providers submitted an average of $18.97 for this code and Medicare allowed $2.88 — 6.6× 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 $2.28 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $2.88
Hospital / facility: $0.01

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 600,510 services were billed in an office setting and 36 in a facility.

Services: 600,546
Beneficiaries: 27,545
Providers billing it: 1,467
Total allowed: $1,729,572

What Medicare pays for HCPCS J9190

Across 600,546 services billed by 1,467 providers to 27,545 beneficiaries, Medicare allowed an average of $2.88 per service. That is 21.8 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 J9190

Specialty	Services	Beneficiaries	Avg allowed	Providers
Hematology-Oncology	425,666	13,851	$2.87	779
Medical Oncology	121,328	4,735	$2.89	268
Internal Medicine	17,084	733	$2.89	45
Hematology	14,048	400	$2.89	20
Dermatology	9,470	4,736	$2.82	215
Nurse Practitioner	3,282	473	$2.83	25
Physician Assistant	2,168	738	$2.86	37
Gynecological Oncology	1,766	70	$2.86	5
Micrographic Dermatologic Surgery	1,380	655	$2.87	23
Ophthalmology	1,259	573	$2.86	30
Radiation Oncology	1,208	38	$2.91	3
Otolaryngology	929	307	$2.90	3
Hematopoietic Cell Transplantation and Cellular Therapy	423	83	$2.85	4
Hospitalist	202	12	$2.92	1
Surgical Oncology	121	11	$2.89	1

J9190 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
Texas	77,629	$2.88	$2.32	186
Florida	72,638	$2.90	$2.31	198
California	50,238	$2.88	$2.30	133
Illinois	42,207	$2.88	$2.30	75
Virginia	30,329	$2.90	$2.32	79
New York	22,306	$2.73	$2.18	51
Tennessee	20,826	$2.87	$2.30	43
Arizona	19,976	$2.91	$2.32	69
Maryland	17,637	$2.86	$2.28	34
Nebraska	16,990	$2.89	$2.29	25
Georgia	15,551	$2.80	$2.27	29
Alabama	15,047	$2.89	$2.33	27
Kansas	14,704	$2.89	$2.29	22
Arkansas	13,530	$2.85	$2.30	26
South Carolina	12,325	$2.90	$2.30	39
Minnesota	11,874	$2.86	$2.27	52
Nevada	11,546	$2.87	$2.30	20
Iowa	11,226	$2.86	$2.29	17
Ohio	11,171	$2.90	$2.31	22
Michigan	11,131	$2.89	$2.29	26
Colorado	10,741	$2.88	$2.30	35
New Jersey	9,993	$2.88	$2.32	24
Missouri	9,023	$2.94	$2.32	27
Indiana	8,755	$2.90	$2.32	18
Pennsylvania	8,331	$2.90	$2.30	23
North Carolina	8,231	$2.86	$2.31	35
Mississippi	6,256	$2.67	$2.31	13
Oklahoma	5,037	$2.92	$2.34	12
New Mexico	4,513	$2.90	$2.30	16
Oregon	4,438	$2.88	$2.32	16
Washington	4,006	$2.89	$2.26	14
Delaware	3,747	$2.91	$2.35	6
Alaska	2,737	$2.93	$2.33	8
South Dakota	2,580	$2.83	$2.25	3
Utah	2,536	$2.85	$2.29	5
Wyoming	1,607	$2.94	$2.36	2
Maine	1,347	$2.88	$2.30	2
Louisiana	1,212	$2.93	$2.33	5
New Hampshire	1,159	$2.96	$2.35	3
Wisconsin	1,153	$2.89	$2.28	4
Vermont	1,089	$2.93	$2.33	2
West Virginia	854	$3.03	$2.42	3
North Dakota	793	$2.91	$2.31	1
Idaho	481	$2.92	$2.22	1
Massachusetts	436	$2.63	$2.36	6
Kentucky	322	$2.87	$2.19	6
Rhode Island	228	$2.93	$2.30	2
Hawaii	36	$0.01	$0.01	1
District of Columbia	25	$2.93	$2.34	1

Related codes

J9144Injection, daratumumab, 10 mg and hyaluronidase-fihj$48.93
J9155Injection, degarelix, 1 mg$4.16
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.