How much does Medicare pay for HCPCS J9280?

Medicare allowed an average of $55.73 per service and paid $44.13 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $200.53, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code J9280?

Injection, mitomycin, 5 mg. It was billed 7,417 times to 860 Medicare beneficiaries by 35 providers in 2024.

Does J9280 pay differently in an office than a hospital?

Yes. The allowed amount averaged $55.26 in an office setting and $56.78 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 J9280 most?

Urology, with 4,548 services from 11 clinicians. Next are Ambulatory Surgical Center, Physician Assistant, Ophthalmology.

HCPCS J9280

Injection, mitomycin, 5 mg

$55.73Medicare-allowed amount per service, averaged across 7,417 services

Providers submitted

$200.53

Asking price, not received

Medicare allowed

$55.73

The fee schedule figure

Medicare paid

$44.13

Balance is patient coinsurance

Providers submitted an average of $200.53 for this code and Medicare allowed $55.73 — 3.6× 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 $44.13 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $55.26
Hospital / facility: $56.78

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 5,111 services were billed in an office setting and 2,306 in a facility.

Services: 7,417
Beneficiaries: 860
Providers billing it: 35
Total allowed: $413,349

What Medicare pays for HCPCS J9280

Across 7,417 services billed by 35 providers to 860 beneficiaries, Medicare allowed an average of $55.73 per service. That is 8.6 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 J9280

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	4,548	174	$55.28	11
Ambulatory Surgical Center	2,306	649	$56.78	21
Physician Assistant	536	15	$55.35	1
Ophthalmology	27	22	$50.79	2

J9280 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	2,790	$56.45	$44.60	7
New Jersey	889	$55.42	$44.29	2
Virginia	680	$50.16	$41.78	2
Oklahoma	648	$54.79	$43.23	2
Delaware	584	$58.83	$46.58	1
Pennsylvania	496	$54.14	$43.69	3
Maryland	330	$57.73	$47.75	3
Arkansas	309	$55.88	$43.69	2
Arizona	232	$62.13	$49.50	2
Tennessee	120	$57.91	$46.14	1
Massachusetts	120	$57.15	$45.53	1
New York	77	$46.31	$44.68	2
Georgia	64	$55.20	$46.26	3
Wisconsin	25	$57.59	$45.88	1
Texas	20	$53.74	$42.82	1
Montana	17	$51.84	$41.30	1
California	16	$46.99	$37.44	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
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

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.