How much does Medicare pay for HCPCS J9201?

Medicare allowed an average of $3.29 per service and paid $2.58 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $167.22, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code J9201?

Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg. It was billed 160,292 times to 8,307 Medicare beneficiaries by 490 providers in 2024.

Which specialty bills J9201 most?

Hematology-Oncology, with 96,689 services from 276 clinicians. Next are Medical Oncology, Urology, Physician Assistant.

HCPCS J9201

Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg

$3.29Medicare-allowed amount per service, averaged across 160,292 services

Providers submitted

$167.22

Asking price, not received

Medicare allowed

$3.29

The fee schedule figure

Medicare paid

$2.58

Balance is patient coinsurance

Providers submitted an average of $167.22 for this code and Medicare allowed $3.29 — 50.8× 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 $2.58 (78%); the rest is the patient’s coinsurance and deductible.

Services: 160,292
Beneficiaries: 8,307
Providers billing it: 490
Total allowed: $527,361

What Medicare pays for HCPCS J9201

Across 160,292 services billed by 490 providers to 8,307 beneficiaries, Medicare allowed an average of $3.29 per service. That is 19.3 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 J9201

Specialty	Services	Beneficiaries	Avg allowed	Providers
Hematology-Oncology	96,689	4,748	$3.28	276
Medical Oncology	25,913	1,495	$3.32	94
Urology	20,568	1,060	$3.31	63
Physician Assistant	6,173	399	$3.32	19
Nurse Practitioner	4,389	181	$3.32	11
Internal Medicine	2,789	166	$3.26	13
Hematology	2,138	139	$3.28	8
Hematopoietic Cell Transplantation and Cellular Therapy	871	86	$3.25	4
Gynecological Oncology	443	12	$3.10	1
Hospitalist	319	21	$3.21	1

J9201 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	15,989	$3.34	$2.65	30
Florida	15,195	$3.34	$2.60	48
Texas	11,901	$3.31	$2.59	48
New York	10,555	$3.05	$2.39	25
Arizona	9,013	$3.30	$2.61	42
Arkansas	8,365	$3.28	$2.61	24
Maryland	7,730	$3.28	$2.61	19
South Carolina	7,119	$3.26	$2.57	21
Illinois	7,022	$3.33	$2.62	22
Minnesota	6,041	$3.25	$2.59	35
Kansas	4,832	$3.28	$2.59	11
Mississippi	4,785	$3.38	$2.64	8
Pennsylvania	4,594	$3.30	$2.56	16
Virginia	4,331	$3.36	$2.62	19
Tennessee	3,998	$3.27	$2.56	13
Missouri	3,828	$3.39	$2.70	15
Colorado	3,474	$3.36	$2.67	10
Alabama	3,050	$3.28	$2.58	8
Nevada	2,804	$3.18	$2.58	9
Washington	2,621	$3.39	$2.63	9
North Carolina	2,606	$3.28	$2.47	6
Nebraska	2,387	$3.31	$2.60	6
Massachusetts	2,367	$3.34	$2.56	4
Iowa	2,039	$3.22	$2.61	3
New Jersey	1,903	$3.30	$2.71	4
Georgia	1,835	$3.20	$2.42	5
Michigan	1,746	$3.27	$2.53	7
Wisconsin	1,427	$3.41	$2.70	4
Oregon	1,218	$3.27	$2.59	5
Indiana	1,066	$3.32	$2.64	2
Ohio	1,036	$3.23	$2.58	2
Utah	900	$3.42	$2.66	1
Louisiana	831	$3.26	$2.54	1
New Mexico	449	$3.20	$2.51	2
Rhode Island	402	$3.52	$2.49	2
Maine	326	$3.20	$2.55	1
Guam	257	$3.28	$2.33	1
District of Columbia	140	$3.40	$2.71	1
Idaho	110	$3.31	$2.64	1

Related codes

J9271Injection, pembrolizumab, 1 mg$55.27
J9299Injection, nivolumab, 1 mg$30.47
J9263Injection, oxaliplatin, 0.5 mg$0.07
J9267Injection, paclitaxel, 1 mg$0.10
J9264Injection, paclitaxel protein-bound particles, 1 mg$13.41
J9217Leuprolide acetate (for depot suspension)$176.80
J9206Injection, irinotecan, 20 mg$2.55
J9260Injection, methotrexate sodium, 50 mg$2.26
J9250Methotrexate sodium$0.30
J9280Injection, mitomycin, 5 mg$55.73

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.