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 35 * 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
Q5127 - Injection, pegfilgrastim-fpgk (stimufend), biosimilar, 0.5 mg 0.5 MG 147.236 - - - - - -
Q5128 - Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg 0.1 MG 83.340 - - - - - -
Q5129 - Injection, bevacizumab-adcd (vegzelma), biosimilar, 10 mg 10 MG 38.158 - - - - - -
Q5130 - Injection, pegfilgrastim-pbbk (fylnetra), biosimilar, 0.5 mg 0.5 MG 127.227 - - - - - -
Q5133 - Injection, tocilizumab-bavi (tofidence), biosimilar, 1 mg 1 MG 5.585 - - - - - -
Q5135 - Injection, tocilizumab-aazg (tyenne), biosimilar, 1 mg 1 MG 4.194 - - - - - -
Q5136 - Injection, denosumab-bbdz (jubbonti/wyost), biosimilar, 1 mg 1 MG 28.230 - - - - - -
Q5138 - Injection, ustekinumab-auub (wezlana), biosimilar, intravenous, 1 mg 1 MG 11.642 - - - - - -
Q5146 - Injection, trastuzumab-strf (hercessi), biosimilar, 10 mg 10 MG 37.151 - - - - - -
Q5147 - Injection, aflibercept-ayyh (pavblu), biosimilar, 1 mg 1 MG 866.203 - - - - - -
Q5148 - Injection, filgrastim-txid (nypozi), biosimilar, 1 microgram 1 MCG 0.997 - - - - - -
Q5151 - Injection, eculizumab-aagh (epysqli), biosimilar, 2 mg 2 MG 31.672 - - - - - -
Q5152 - Injection, eculizumab-aeeb (bkemv), biosimilar, 2 mg 2 MG 42.347 - - - - - -
Q9950 - Injection, sulfur hexafluoride lipid microspheres, per ml 1 ML 18.166 - - - - - -
Q9956 - Injection, octafluoropropane microspheres, per ml 1 ML 40.207 - - - - - -
Q9957 - Injection, perflutren lipid microspheres, per ml 1 ML 40.207 - - - - - -
Q9958 - High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml 1 ML 0.074 - - - - - -
Q9961 - High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml 1 ML 0.255 - - - - - -
Q9963 - High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml 1 ML 0.223 - - - - - -
Q9965 - Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml 1 ML 1.036 - - - - - -
Q9966 - Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml 1 ML 0.401 - - - - - -
Q9967 - Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml 1 ML 0.149 - - - - - -
Q9991 - Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg Less than or equal to 100 MG 1998.533 - - - - - -
Q9992 - Injection, buprenorphine extended-release (sublocade), greater than 100 mg Greater than 100 MG 1998.533 - - - - - -
Q9997 - Injection, ustekinumab-ttwe (pyzchiva), intravenous, 1 mg 1 MG 8.268 - - - - - -
* Effective January 1, 2026 through March 31, 2026

ASP (Average Sale Price) Drug Pricing History