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 7 * 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
J0690 - Injection, cefazolin sodium, 500 mg 500 MG 0.827 - - - - - -
J0692 - Injection, cefepime hydrochloride, 500 mg 500 MG 0.866 - - - - - -
J0694 - Injection, cefoxitin sodium, 1 gm 1 GM 4.742 - - - - - -
J0695 - Injection, ceftolozane 50 mg and tazobactam 25 mg 75mg (50mg cft/25mg taz) 8.947 - - - - - -
J0696 - Injection, ceftriaxone sodium, per 250 mg 250 MG 0.462 - - - - - -
J0697 - Injection, sterile cefuroxime sodium, per 750 mg 750 MG 2.054 - - - - - -
J0699 - Injection, cefiderocol, 10 mg 10 mg 2.419 - - - - - -
J0701 - Injection, cefepime hydrochloride (baxter), not therapeutically equivalent to maxipime, 500 mg 500 MG 5.970 - - - - - -
J0702 - Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg 3 MG & 3 MG 6.908 - - - - - -
J0703 - Injection, cefepime hydrochloride (b braun), not therapeutically equivalent to maxipime, 500 mg 500 MG 4.954 - - - - - -
J0712 - Injection, ceftaroline fosamil, 10 mg 10 MG 4.239 - - - - - -
J0713 - Injection, ceftazidime, per 500 mg 500 MG 1.468 - - - - - -
J0714 - Injection, ceftazidime and avibactam, 0.5 g/0.125 g .625 GM 104.709 - - - - - -
J0717 - Injection, certolizumab pegol, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) 1 MG 3.867 - - - - - -
J0725 - Injection, chorionic gonadotropin, per 1,000 usp units 1000 UNITS 15.400 - - - - - -
J0735 - Injection, clonidine hydrochloride, 1 mg 1 MG 17.228 - - - - - -
J0736 - Injection, clindamycin phosphate, 300 mg 300 MG 1.913 - - - - - -
J0737 - Injection, clindamycin phosphate (baxter), not therapeutically equivalent to j0736, 300 mg 300 MG 2.346 - - - - - -
J0738 - Injection, lenacapavir, 1 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv) 1 MG 16.133 - - - - - -
J0739 - Injection, cabotegravir, 1mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv) 1 mg 7.147 - - - - - -
J0740 - Injection, cidofovir, 375 mg 375 MG 524.483 - - - - - -
J0741 - Injection, cabotegravir and rilpivirine, 2mg/3mg 2MG/3MG 24.164 - - - - - -
J0742 - Injection, imipenem 4 mg, cilastatin 4 mg and relebactam 2 mg 4 MG-4 MG-2 MG 2.600 - - - - - -
J0743 - Injection, cilastatin sodium; imipenem, per 250 mg 250 MG 7.101 - - - - - -
J0744 - Injection, ciprofloxacin for intravenous infusion, 200 mg 200 MG 1.997 - - - - - -
* Effective January 1, 2026 through March 31, 2026

ASP (Average Sale Price) Drug Pricing History