Cost analysis for CPT J3590 — Unclassified biologics
Average Medicare Payment
$825.95
2023 data
Total Payments (2023)
$35.4M
Services (2023)
124.3K
Price Change (2014–2023)
+1572.6%
| Year | Avg Payment | Total Payments | Services | YoY Change |
|---|---|---|---|---|
| 2014 | $49.38 | $16.8M | 378.6K | — |
| 2015 | $89.60 | $23.6M | 372.1K | +81.4% |
| 2016 | $100.66 | $11.9M | 222.4K | +12.3% |
| 2017 | $344.90 | $21.0M | 317.4K | +242.6% |
| 2018 | $169.32 | $11.2M | 199.8K | -50.9% |
| 2019 | $234.25 | $14.3M | 190.9K | +38.3% |
| 2020 | $232.08 | $15.6M | 175.0K | -0.9% |
| 2021 | $57.95 | $8.7M | 146.7K | -75.0% |
| 2022 | $909.74 | $91.1M | 187.2K | +1469.9% |
| 2023 | $825.95 | $35.4M | 124.3K | -9.2% |
The most expensive state pays 56.5x more than the cheapest for this procedure. NC averages $2541.93 vs WI at $44.97.
| State | Avg Payment | Total Payments | Services | Providers |
|---|---|---|---|---|
| NC | $2541.93 | $1.3M | 523 | 14 |
| MD | $2389.63 | $2.8M | 1.2K | 22 |
| VA | $2282.74 | $1.9M | 828 | 15 |
| CO | $2221.25 | $473.1K | 213 | 5 |
| NJ | $2187.56 | $3.6M | 1.6K | 23 |
| GA | $2119.74 | $235.3K | 111 | 3 |
| CT | $2104.31 | $763.9K | 363 | 6 |
| MA | $2095.70 | $326.9K | 156 | 4 |
| NV | $2050.54 | $701.3K | 342 | 3 |
| NH | $2043.10 | $404.5K | 198 | 2 |
| PA | $1700.94 | $935.5K | 550 | 12 |
| SC | $1653.94 | $253.1K | 153 | 3 |
| TX | $1642.30 | $5.9M | 3.6K | 36 |
| SD | $1449.59 | $324.7K | 224 | 4 |
| NY | $1438.44 | $1.4M | 960 | 19 |
| NM | $1415.29 | $587.3K | 415 | 6 |
| FL | $1367.20 | $855.9K | 626 | 17 |
| WA | $961.08 | $171.1K | 178 | 7 |
| CA | $835.39 | $1.8M | 2.1K | 22 |
| LA | $488.48 | $460.1K | 942 | 5 |
| OR | $325.27 | $42.0K | 129 | 2 |
| IL | $316.48 | $325.3K | 1.0K | 9 |
| TN | $297.72 | $259.9K | 873 | 12 |
| MN | $229.78 | $515.6K | 2.2K | 7 |
| MO | $160.66 | $550.4K | 3.4K | 29 |
| AZ | $121.81 | $20.7K | 170 | 2 |
| IA | $99.53 | $829.2K | 8.3K | 31 |
| KS | $97.23 | $505.8K | 5.2K | 21 |
| OH | $96.06 | $3.1M | 32.2K | 103 |
| MI | $77.28 | $1.5M | 19.0K | 75 |
| NE | $66.30 | $415.8K | 6.3K | 14 |
| IN | $63.70 | $1.2M | 18.9K | 49 |
| KY | $62.49 | $680.2K | 10.9K | 40 |
| WI | $44.97 | $10.3K | 228 | 1 |
| Provider | Specialty | State | Payments | Services | Avg/Service |
|---|---|---|---|---|---|
| David Brown | Ophthalmology | TX | $922.7K | 454 | $2032.44 |
| Tien Wong | Ophthalmology | TX | $781.8K | 384 | $2035.89 |
| Robert Barone | Ophthalmology | NJ | $495.6K | 234 | $2117.93 |
| Alexander Melamud | Ophthalmology | VA | $481.2K | 202 | $2382.08 |
| Jordana Fein | Ophthalmology | VA | $428.4K | 175 | $2448.13 |
| Irene Voo | Ophthalmology | NV | $415.1K | 195 | $2128.74 |
| Daniel Berinstein | Ophthalmology | MD | $392.2K | 166 | $2362.36 |
| Vinod Voleti | Ophthalmology | NJ | $385.8K | 167 | $2310.14 |
| Matthew Benz | Ophthalmology | TX | $363.5K | 184 | $1975.65 |
| John Pitcher | Ophthalmology | NM | $345.2K | 159 | $2171.07 |
| Kinley Beck | Ophthalmology | NH | $334.6K | 165 | $2027.77 |
| Moises Chica | Ophthalmology | TX | $333.1K | 158 | $2108.20 |
| Howard Fine | Ophthalmology | NJ | $324.3K | 147 | $2206.26 |
| Ankoor Shah | Ophthalmology | TX | $316.7K | 160 | $1979.35 |
| Sumit Shah | Ophthalmology | NJ | $311.6K | 146 | $2134.26 |
| Szilard Kiss | Ophthalmology | NY | $278.9K | 133 | $2097.16 |
| Marisa Lau | Ophthalmology | CO | $265.0K | 122 | $2171.86 |
| Michael Lai | Ophthalmology | MD | $256.5K | 104 | $2466.24 |
| Jonathan Greenberg | Ophthalmology | NJ | $252.2K | 107 | $2357.47 |
| Raynor Casey | Ophthalmology | NC | $250.1K | 93 | $2689.56 |
The data suggests significant pricing inconsistencies for CPT J3590. With a 56.5x price gap between the most and least expensive states, geography plays an outsized role in what Medicare pays for this procedure.
Costs have risen 1572.6% since 2014, outpacing inflation and raising questions about whether reimbursement rates reflect actual costs.
This analysis is based on publicly available CMS data and does not account for patient complexity, comorbidities, or facility-specific factors that may justify pricing differences.
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.