HCPCS J0717

Injection, certolizumab pegol, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) (CMS descriptor)

Drugs Drug code Work RVU per service none (2021 fee schedule; adds 0 work RVUs)

751
83rd percentile among 6,253 codes billed · 2021
$272M
99th percentile among 6,253 codes billed · 2021
47.2M
100th percentile among 6,253 codes billed · 2021
48,400
100th percentile among 6,253 codes billed · 2021
172,700
100th percentile among 6,253 codes billed · 2021
+1.9%
Medicare payment on the code vs 2020; billers +13.4% · 2021

Trend

Medicare payment on the code

$0$100M$200M2020: $267M paid20202021: $272M paid20212022: $233M paid20222023: $215M paid20232024: $220M paid2024$220M$0$100M$200M2020: $267M paid20202021: $272M paid20212022: $233M paid20222023: $215M paid20232024: $220M paid2024$220M$0$100M$200M2020: $267M paid20202021: $272M paid20212022: $233M paid20222023: $215M paid20232024: $220M paid2024$220M$0$100M$200M2020: $267M paid20202021: $272M paid20212022: $233M paid20222023: $215M paid20232024: $220M paid2024$220M

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2020–2024.

Billers

05001,0002020: 662 providers20202021: 751 providers20212022: 815 providers20222023: 848 providers20232024: 958 providers202495805001,0002020: 662 providers20202021: 751 providers20212022: 815 providers20222023: 848 providers20232024: 958 providers202495805001,0002020: 662 providers20202021: 751 providers20212022: 815 providers20222023: 848 providers20232024: 958 providers202495805001,0002020: 662 providers20202021: 751 providers20212022: 815 providers20222023: 848 providers20232024: 958 providers2024958

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2020–2024.

observed calculated calculated calculated calculated calculated reported
2024958$220,117,291+3%61,165,04545,600196,4000.00
2023848$214,619,140-8%55,220,40248,400170,2400.00
2022815$232,670,295-14%51,914,53148,000168,0000.00
2021751$271,682,287+2%47,180,23248,400172,7000.00
2020662$266,528,248first year in data41,410,51946,400179,8900.00

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2020–2024.

By state

observed calculated calculated calculated calculated calculated
Florida103$42,746,2887,367,87052,400217,260
Texas74$30,440,9695,319,61459,000183,200
Pennsylvania55$17,860,6203,110,80349,800111,360
New Jersey52$17,813,7673,104,81638,600212,580
California49$17,257,0623,024,38449,200149,122
Virginia32$16,355,8272,848,50270,424199,350
Illinois38$12,627,2992,177,67147,102152,030
Kentucky17$9,249,7271,612,60170,000229,520
North Carolina41$8,278,7341,451,20327,20090,400
Tennessee18$7,904,5461,368,21159,600180,640
Maryland24$7,825,4671,361,60046,400172,020
New York22$6,012,2671,044,60144,10079,790
South Carolina19$5,719,5141,000,00043,600122,940
Arizona17$5,480,616941,00640,800126,881
Arkansas14$5,230,003913,40254,600179,880

Not listed: 28 states with fewer than 11 billers (small cells).

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Providers placed by practice address. Data year 2021.

Top metro areas

observed calculated calculated calculated calculated
New York-Newark-Jersey City, NY-NJ51$18,023,6693,131,21643,200
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD40$13,511,3432,356,80431,900
Chicago-Naperville-Elgin, IL-IN40$13,440,5082,320,87149,200
Houston-Pasadena-The Woodlands, TX28$13,334,8442,336,60165,000
Miami-Fort Lauderdale-West Palm Beach, FL34$10,442,9731,808,45943,700
Washington-Arlington-Alexandria, DC-VA-MD-WV18$8,403,2881,459,69165,400
Tampa-St. Petersburg-Clearwater, FL21$7,134,5441,228,60151,600
Baltimore-Columbia-Towson, MD14$6,040,8721,052,80056,800
Dallas-Fort Worth-Arlington, TX15$5,463,449955,00256,800
Kansas City, MO-KS16$5,188,955897,66046,400
Los Angeles-Long Beach-Anaheim, CA13$5,047,580902,02246,814
Phoenix-Mesa-Chandler, AZ12$4,426,441758,20647,100
San Antonio-New Braunfels, TX11$3,255,141570,40154,800
Charlotte-Concord-Gastonia, NC-SC16$1,952,650337,20118,000
Des Moines-West Des Moines, IA12$1,765,840303,80020,200

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). The 15 areas with the most payment among those with at least 11 billers; non-metro parts of each state are one area. Data year 2021.

Specialties billing J0717 nationally

Rheumatology accounts for 91% of payment for J0717 nationally in 2021, across 4 specialties on claims.

observed calculated calculated calculated calculated calculated
Rheumatology66589%$246,112,02391%42,765,73464,309
Internal Medicine314.1%$10,439,9503.8%1,808,08158,325
Nurse Practitioner314.1%$9,530,6423.5%1,643,00353,000
Physician Assistant131.7%$2,378,2740.88%410,40431,570

Not listed: 6 specialties with fewer than 11 billers (small cells).

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Provider-level lines (fewer than 11 beneficiaries suppressed by CMS); specialty is the provider type on claims. Data year 2021.

Top billers of J0717 nationally

Named top billers are a Pro figure, and Pro is not available to buy, so this list is not shown to any account. The counts and totals by state, metro area and specialty on this page are free.

Original Medicare Part B fee-for-service only; CMS suppresses provider lines with fewer than 11 beneficiaries. How these figures are computed · Limitations