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 9 * 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
J0887 - Injection, epoetin beta, 1 microgram, (for esrd on dialysis) 1 MCG 1.215 - - - - - -
J0888 - Injection, epoetin beta, 1 microgram, (for non esrd use) 1 MCG 1.215 - - - - - -
J0893 - Injection, decitabine (sun pharma), not therapeutically equivalent to j0894, 1 mg 1 MG 0.777 - - - - - -
J0894 - Injection, decitabine, 1 mg 1 MG 0.648 - - - - - -
J0895 - Injection, deferoxamine mesylate, 500 mg 500 MG 8.468 - - - - - -
J0896 - Injection, luspatercept-aamt, 0.25 mg 0.25 MG 42.773 - - - - - -
J0897 - Injection, denosumab, 1 mg 1 MG 29.457 - - - - - -
J0898 - Injection, argatroban (auromedics), not therapeutically equivalent to j0883, 1 mg (for non-esrd use) 1 MG 1.453 - - - - - -
J0899 - Injection, argatroban (auromedics), not therapeutically equivalent to j0884, 1 mg (for esrd on dialysis) 1 MG 1.453 - - - - - -
J0901 - Vadadustat, oral, 1 mg (for esrd on dialysis) 1 MG 0.143 - - - - - -
J1000 - Injection, depo-estradiol cypionate, up to 5 mg 5 MG 51.816 - - - - - -
J1010 - Injection, methylprednisolone acetate, 1 mg 1 MG 0.120 - - - - - -
J1071 - Injection, testosterone cypionate, 1 mg 1 MG 0.027 - - - - - -
J1072 - Injection, testosterone cypionate (azmiro), 1 mg 1 MG 1.325 - - - - - -
J1096 - Dexamethasone, lacrimal ophthalmic insert, 0.1 mg 0.1 MG 98.657 - - - - - -
J1100 - Injection, dexamethasone sodium phosphate, 1 mg 1 MG 0.105 - - - - - -
J1110 - Injection, dihydroergotamine mesylate, per 1 mg 1 MG 57.082 - - - - - -
J1120 - Injection, acetazolamide sodium, up to 500 mg 500 MG 25.594 - - - - - -
J1160 - Injection, digoxin, up to 0.5 mg 0.5 MG 9.574 - - - - - -
J1162 - Injection, digoxin immune fab (ovine), per vial PER VIAL 5166.991 - - - - - -
J1163 - Injection, diltiazem hydrochloride, 0.5 mg 0.5 MG 0.030 - - - - - -
J1165 - Injection, phenytoin sodium, per 50 mg 50 MG 0.595 - - - - - -
J1171 - Injection, hydromorphone, 0.1 mg 0.1 MG 0.140 - - - - - -
J1190 - Injection, dexrazoxane hydrochloride, per 250 mg 250 MG 58.013 - - - - - -
J1200 - Injection, diphenhydramine hcl, up to 50 mg 50 MG 0.713 - - - - - -
* Effective January 1, 2026 through March 31, 2026

ASP (Average Sale Price) Drug Pricing History