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 21 * 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
J3385 - Injection, velaglucerase alfa, 100 units 100 UNITS 386.428 - - - - - -
J3396 - Injection, verteporfin, 0.1 mg 0.1 MG 11.556 - - - - - -
J3401 - Beremagene geperpavec-svdt for topical administration, containing nominal 5 x 10^9 pfu/ml vector genomes, per 0.1 ml 0.1 ML 1014.786 - - - - - -
J3402 - Injection, remestemcel-l-rknd, per therapeutic dose Per Therapeutic Dose 201669.021 - - - - - -
J3403 - Revakinagene taroretcel-lwey, per implant PER IMPLANT 265000.000 - - - - - -
J3410 - Injection, hydroxyzine hcl, up to 25 mg 25 MG 13.000 - - - - - -
J3411 - Injection, thiamine hcl, 100 mg 100 MG 1.806 - - - - - -
J3415 - Injection, pyridoxine hcl, 100 mg 100 MG 15.555 - - - - - -
J3420 - Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg 1000 MCG 0.638 - - - - - -
J3425 - Injection, hydroxocobalamin, intramuscular, 10 mcg 10 MCG 0.008 - - - - - -
J3430 - Injection, phytonadione (vitamin k), per 1 mg 1 MG 2.808 - - - - - -
J3465 - Injection, voriconazole, 10 mg 10 MG 0.751 - - - - - -
J3470 - Injection, hyaluronidase, up to 150 units 150 UNITS 31.807 - - - - - -
J3471 - Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units) 1 USP UNIT 0.499 - - - - - -
J3473 - Injection, hyaluronidase, recombinant, 1 usp unit 1 USP UNIT 0.363 - - - - - -
J3475 - Injection, magnesium sulfate, per 500 mg 500 MG 0.405 - - - - - -
J3480 - Injection, potassium chloride, per 2 meq 2 MEQ 0.121 - - - - - -
J3485 - Injection, zidovudine, 10 mg 10 MG 1.513 - - - - - -
J3486 - Injection, ziprasidone mesylate, 10 mg 10 MG 9.148 - - - - - -
J3489 - Injection, zoledronic acid, 1 mg 1 MG 5.082 - - - - - -
J7030 - Infusion, normal saline solution , 1000 cc 1000 CC 1.989 - - - - - -
J7040 - Infusion, normal saline solution, sterile (500 ml = 1 unit) 500 ML 1.286 - - - - - -
J7042 - 5% dextrose/normal saline (500 ml = 1 unit) 500 ML 1.310 - - - - - -
J7050 - Infusion, normal saline solution, 250 cc 250 CC 0.664 - - - - - -
J7060 - 5% dextrose/water (500 ml = 1 unit) 500 ML 1.746 - - - - - -
* Effective January 1, 2026 through March 31, 2026

ASP (Average Sale Price) Drug Pricing History