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 22 * 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
J7070 - Infusion, d5w, 1000 cc 1000 CC 2.936 - - - - - -
J7120 - Ringers lactate infusion, up to 1000 cc 1000 CC 2.384 - - - - - -
J7170 - Injection, emicizumab-kxwh, 0.5 mg 0.5 MG 56.464 - - - - - - 1
J7171 - Injection, adamts13, recombinant-krhn, 10 iu 10 UNITS 35.478 - - - - - -
J7172 - Injection, marstacimab-hncq, 0.5 mg 0.5 MG 50.473 - - - - - - 1
J7173 - Injection, concizumab-mtci, 0.5 mg 0.5 MG 85.503 - - - - - - 1
J7174 - Injection, fitusiran, 0.04 mg 0.04 MG 132.620 - - - - - - 1
J7175 - Injection, factor x, (human), 1 i.u. 1 IU 9.921 - - - - - - 1
J7177 - Injection, human fibrinogen concentrate (fibryga), 1 mg 1 MG 1.226 - - - - - - 1
J7178 - Injection, human fibrinogen concentrate, not otherwise specified, 1 mg 1 MG 1.525 - - - - - - 1
J7179 - Injection, von willebrand factor (recombinant), (vonvendi), 1 i.u. vwf:rco 1 IU 1.836 - - - - - - 1
J7180 - Injection, factor xiii (antihemophilic factor, human), 1 i.u. 1 IU 10.763 - - - - - - 1
J7181 - Injection, factor xiii a-subunit, (recombinant), per iu 1 IU 18.564 - - - - - - 1
J7182 - Injection, factor viii, (antihemophilic factor, recombinant), (novoeight), per iu 1 IU 1.551 - - - - - - 1
J7183 - Injection, von willebrand factor complex (human), wilate, 1 i.u. vwf:rco 1 I.U. VWF:RCO 1.324 - - - - - - 1
J7185 - Injection, factor viii (antihemophilic factor, recombinant) (xyntha), per i.u. 1 IU 1.588 - - - - - - 1
J7186 - Injection, antihemophilic factor viii/von willebrand factor complex (human), per factor viii i.u. PER FACTOR VIII IU 1.241 - - - - - - 1
J7187 - Injection, von willebrand factor complex (humate-p), per iu vwf:rco 1 IU 1.491 - - - - - - 1
J7188 - Injection, factor viii (antihemophilic factor, recombinant), (obizur), per i.u. 1 IU 3.234 - - - - - - 1
J7189 - Factor viia (antihemophilic factor, recombinant), (novoseven rt), 1 microgram 1 MCG 2.622 - - - - - - 1
J7190 - Factor viii (antihemophilic factor, human) per i.u. 1 IU 1.113 - - - - - - 1
J7192 - Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified 1 IU 1.591 - - - - - - 1
J7193 - Factor ix (antihemophilic factor, purified, non-recombinant) per i.u. 1 IU 1.368 - - - - - - 1
J7194 - Factor ix, complex, per i.u. 1 IU 1.703 - - - - - - 1
J7195 - Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified 1 IU 1.834 - - - - - - 1
* Effective January 1, 2026 through March 31, 2026

ASP (Average Sale Price) Drug Pricing History