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 (2022 fee schedule; adds 0 work RVUs)

815
84th percentile among 6,326 codes billed · 2022
$233M
99th percentile among 6,326 codes billed · 2022
51.9M
100th percentile among 6,326 codes billed · 2022
48,000
100th percentile among 6,326 codes billed · 2022
168,000
100th percentile among 6,326 codes billed · 2022
-14.4%
Medicare payment on the code vs 2021; billers +8.5% · 2022

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
Florida117$37,158,8848,252,13048,800221,320
Texas94$28,334,4686,340,66650,001170,220
Pennsylvania66$15,589,1833,477,60034,500130,400
New Jersey57$15,140,6313,373,70348,400142,880
California46$14,736,5173,304,11751,801160,100
Virginia30$13,400,8972,982,64782,200245,780
Illinois40$10,599,4442,361,64849,600153,370
Kentucky18$8,434,6251,898,84276,400231,361
North Carolina40$6,952,9171,553,86132,00198,660
Tennessee21$6,854,8851,535,20250,800166,400
Maryland24$6,361,4041,426,80043,200156,300
New York26$5,572,7981,241,28243,80084,500
Arizona22$5,527,6361,227,16035,700150,140
South Carolina22$5,330,8571,199,40041,700116,330
Delaware11$4,956,5501,101,60095,600183,800

Not listed: 24 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 2022.

Top metro areas

observed calculated calculated calculated calculated
New York-Newark-Jersey City, NY-NJ58$15,692,3343,494,98547,800
Chicago-Naperville-Elgin, IL-IN42$11,361,4632,530,84851,400
Houston-Pasadena-The Woodlands, TX31$11,184,8302,496,26267,200
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD46$10,860,4912,419,20029,900
Miami-Fort Lauderdale-West Palm Beach, FL38$9,190,2622,038,93743,213
Washington-Arlington-Alexandria, DC-VA-MD-WV15$6,858,9661,531,00693,200
Dallas-Fort Worth-Arlington, TX26$6,198,9641,385,20340,800
Tampa-St. Petersburg-Clearwater, FL23$6,078,2011,353,65136,630
Baltimore-Columbia-Towson, MD16$5,048,4261,134,20048,600
Phoenix-Mesa-Chandler, AZ17$4,425,066981,16043,600
Los Angeles-Long Beach-Anaheim, CA14$4,265,642969,61443,504
Kansas City, MO-KS15$4,237,016944,00152,000
Orlando-Kissimmee-Sanford, FL11$4,022,585893,26473,200
San Antonio-New Braunfels, TX13$3,116,092700,40040,000
Austin-Round Rock-San Marcos, TX11$2,925,598654,20144,400

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). The 19 areas with the most payment among those with at least 11 billers; non-metro parts of each state are one area. Data year 2022.

Specialties billing J0717 nationally

Rheumatology accounts for 91% of payment for J0717 nationally in 2022, across 3 specialties on claims.

observed calculated calculated calculated calculated calculated
Rheumatology72088%$210,991,88491%47,086,82665,398
Internal Medicine384.7%$9,855,5564.2%2,203,20157,979
Nurse Practitioner354.3%$7,375,8583.2%1,636,00446,743

Not listed: 5 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 2022.

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