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 19 * 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
J2798 - Injection, risperidone, (perseris), 0.5 mg 0.5 mg 12.139 - - - - - -
J2799 - Injection, risperidone (uzedy), 1 mg 1 MG 25.044 - - - - - -
J2800 - Injection, methocarbamol, up to 10 ml 10 ML 4.535 - - - - - -
J2802 - Injection, romiplostim, 1 microgram 1 MCG 11.048 - - - - - -
J2804 - Injection, rifampin, 1 mg 1 MG 0.153 - - - - - -
J2805 - Injection, sincalide, 5 micrograms 5 MCG 110.129 - - - - - -
J2820 - Injection, sargramostim (gm-csf), 50 mcg 50 MCG 61.745 - - - - - -
J2860 - Injection, siltuximab, 10 mg 10 MG 168.678 - - - - - -
J2865 - Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg 5MG-1MG 0.038 - - - - - -
J2916 - Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg 12.5 MG 2.214 - - - - - -
J2919 - Injection, methylprednisolone sodium succinate, 5 mg 5 MG 0.264 - - - - - -
J2997 - Injection, alteplase recombinant, 1 mg 1 MG 93.832 - - - - - -
J3000 - Injection, streptomycin, up to 1 gm 1 GM 33.877 - - - - - -
J3010 - Injection, fentanyl citrate, 0.1 mg 0.1 MG 1.188 - - - - - -
J3032 - Injection, eptinezumab-jjmr, 1 mg 1 MG 20.502 - - - - - -
J3055 - Injection, talquetamab-tgvs, 0.25 mg 0.25 MG 74.915 - - - - - -
J3060 - Injection, taliglucerase alfa, 10 units 10 UNITS 40.943 - - - - - -
J3090 - Injection, tedizolid phosphate, 1 mg 1 MG 1.964 - - - - - -
J3095 - Injection, telavancin, 10 mg 10 MG 7.368 - - - - - -
J3101 - Injection, tenecteplase, 1 mg 1 MG 186.972 - - - - - -
J3105 - Injection, terbutaline sulfate, up to 1 mg 1 MG 2.473 - - - - - -
J3111 - Injection, romosozumab-aqqg, 1 mg 1 MG 12.109 - - - - - -
J3121 - Injection, testosterone enanthate, 1 mg 1 MG 0.051 - - - - - -
J3145 - Injection, testosterone undecanoate, 1 mg 1 MG 2.069 - - - - - -
J3230 - Injection, chlorpromazine hcl, up to 50 mg 50 MG 23.767 - - - - - -
* Effective January 1, 2026 through March 31, 2026

ASP (Average Sale Price) Drug Pricing History