HCPCS J9263

Across 7,035,422 services billed by 523 providers to 7,954 beneficiaries, Medicare allowed an average of $0.07 per service. That is 884.5 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.

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.

• J9271Injection, pembrolizumab, 1 mg$55.27
• J9299Injection, nivolumab, 1 mg$30.47
• J9267Injection, paclitaxel, 1 mg$0.10
• J9264Injection, paclitaxel protein-bound particles, 1 mg$13.41
• J9217Leuprolide acetate (for depot suspension)$176.80
• J9201Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg$3.29
• J9206Injection, irinotecan, 20 mg$2.55
• J9260Injection, methotrexate sodium, 50 mg$2.26
• J9250Methotrexate sodium$0.30
• J9280Injection, mitomycin, 5 mg$55.73

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.

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