ASP Drug Pricing - (1st Quarter)
January 2026
Payment Allowance Limits for Medicare Part B Drugs

  • Note 1: Payment allowance limits subject to the ASP methodology are based on Jul 2025 (3nd Quarter) ASP data.
  • Note 2: The absence or presence of a HCPCS code and the payment allowance limits in this table does not indicate whether Medicare covers a drug. These determinations shall be made by the local Medicare contractor processing the claim.
 
Page 13 * Effective January 1, 2026 through March 31, 2026
HCPCS Code Code Dosage Payment
Limit		 Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
J1631 - Injection, haloperidol decanoate, per 50 mg 50 MG 3.939 - - - - - -
J1640 - Injection, hemin, 1 mg 1 MG 35.309 - - - - - -
J1642 - Injection, heparin sodium, (heparin lock flush), per 10 units 10 UNITS 0.018 - - - - - -
J1643 - Injection, heparin sodium (pfizer), not therapeutically equivalent to j1644, per 1000 units 1000 UNITS 2.101 - - - - - -
J1644 - Injection, heparin sodium, per 1000 units 1000 UNITS 0.179 - - - - - -
J1645 - Injection, dalteparin sodium, per 2500 iu 2500 IU 14.904 - - - - - -
J1650 - Injection, enoxaparin sodium, 10 mg 10 MG 0.533 - - - - - -
J1652 - Injection, fondaparinux sodium, 0.5 mg 0.5 MG 0.877 - - - - - -
J1670 - Injection, tetanus immune globulin, human, up to 250 units 250 UNITS 588.540 - - - - - -
J1720 - Injection, hydrocortisone sodium succinate, up to 100 mg 100 MG 22.061 - - - - - -
J1740 - Injection, ibandronate sodium, 1 mg 1 MG 13.142 - - - - - -
J1741 - Injection, ibuprofen, 100 mg 100 MG 3.183 - - - - - -
J1743 - Injection, idursulfase, 1 mg 1 MG 558.102 - - - - - -
J1745 - Injection, infliximab, excludes biosimilar, 10 mg 10 MG 32.423 - - - - - -
J1746 - Injection, ibalizumab-uiyk, 10 mg 10 MG 77.538 - - - - - -
J1747 - Injection, spesolimab-sbzo, 1 mg 1 MG 65.728 - - - - - -
J1749 - Injection, iloprost, 0.1 mcg 0.1 MCG 5.713 - - - - - -
J1750 - Injection, iron dextran, 50 mg 50 MG 18.081 - - - - - -
J1756 - Injection, iron sucrose, 1 mg 1 MG 0.236 - - - - - -
J1786 - Injection, imiglucerase, 10 units 10 UNITS 43.232 - - - - - -
J1790 - Injection, droperidol, up to 5 mg up to 5 MG 7.180 - - - - - -
J1805 - Injection, esmolol hydrochloride, 10 mg 10 MG 0.212 - - - - - -
J1806 - Injection, esmolol hydrochloride (wg critical care), not therapeutically equivalent to j1805, 10 mg 10 MG 0.410 - - - - - -
J1808 - Injection, folic acid, 0.1 mg 0.1 MG 0.053 - - - - - -
J1809 - Injection, fosdenopterin, 0.1 mg 0.1 MG 17.238 - - - - - -
* Effective January 1, 2026 through March 31, 2026

ASP (Average Sale Price) Drug Pricing History