ASP Drug Pricing - (2nd Quarter)
April 2026
Payment Allowance Limits for Medicare Part B Drugs

  • Note 1: Payment allowance limits subject to the ASP methodology are based on Oct 2025 (4th Quarter) ASP data.
  • Note 2: The absence or presence of a HCPCS code and the payment allowance limits in this table does not indicate Medicare coverage of the drug. Similarly, the inclusion of a payment allowance limit within a specific column does not indicate Medicare coverage of the drug in that specific category. These determinations shall be made by the local Medicare contractor processing the claim.
 
Page 20 * Effective April 1, 2026 through June 30, 2026
HCPCS Code Code Dosage Payment
Limit		 Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
J3411 - Injection, thiamine hcl, 100 mg 100 MG 1.554 - - - - - -
J3415 - Injection, pyridoxine hcl, 100 mg 100 MG 14.895 - - - - - -
J3420 - Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg 1000 MCG 0.667 - - - - - -
J3425 - Injection, hydroxocobalamin, intramuscular, 10 mcg 10 MCG 0.007 - - - - - -
J3430 - Injection, phytonadione (vitamin k), per 1 mg 1 MG 3.156 - - - - - -
J3465 - Injection, voriconazole, 10 mg 10 MG 0.652 - - - - - -
J3470 - Injection, hyaluronidase, up to 150 units 150 UNITS 31.55 - - - - - -
J3473 - Injection, hyaluronidase, recombinant, 1 usp unit 1 USP UNIT 0.363 - - - - - -
J3475 - Injection, magnesium sulfate, per 500 mg 500 MG 0.431 - - - - - -
J3480 - Injection, potassium chloride, per 2 meq 2 MEQ 0.127 - - - - - -
J3485 - Injection, zidovudine, 10 mg 10 MG 1.513 - - - - - -
J3486 - Injection, ziprasidone mesylate, 10 mg 10 MG 5.873 - - - - - -
J3489 - Injection, zoledronic acid, 1 mg 1 MG 30.878 - - - - - -
J7030 - Infusion, normal saline solution , 1000 cc 1000 CC 2.185 - - - - - -
J7040 - Infusion, normal saline solution, sterile (500 ml = 1 unit) 500 ML 1.355 - - - - - -
J7042 - 5% dextrose/normal saline (500 ml = 1 unit) 500 ML 1.285 - - - - - -
J7050 - Infusion, normal saline solution, 250 cc 250 CC 0.703 - - - - - -
J7060 - 5% dextrose/water (500 ml = 1 unit) 500 ML 1.874 - - - - - -
J7070 - Infusion, d5w, 1000 cc 1000 CC 3.07 - - - - - -
J7120 - Ringers lactate infusion, up to 1000 cc 1000 CC 2.601 - - - - - -
J7170 - Injection, emicizumab-kxwh, 0.5 mg 0.5 MG 55.64 - - - - - - 1
J7171 - Injection, adamts13, recombinant-krhn, 10 iu 10 UNITS 35.576 - - - - - -
J7172 - Injection, marstacimab-hncq, 0.5 mg 0.5 MG 50.191 - - - - - - 1
J7173 - Injection, concizumab-mtci, 0.5 mg 0.5 MG 83.472 - - - - - - 1
J7174 - Injection, fitusiran, 0.04 mg 0.04 MG 132.626 - - - - - - 1
* Effective April 1, 2026 through June 30, 2026

ASP (Average Sale Price) Drug Pricing History