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 34 * 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
Q5129 - Injection, bevacizumab-adcd (vegzelma), biosimilar, 10 mg 10 MG 34.654 - - - - - -
Q5130 - Injection, pegfilgrastim-pbbk (fylnetra), biosimilar, 0.5 mg 0.5 MG 112.133 - - - - - -
Q5133 - Injection, tocilizumab-bavi (tofidence), biosimilar, 1 mg 1 MG 5.259 - - - - - -
Q5134 - Injection, natalizumab-sztn (tyruko), biosimilar, 1 mg 1 MG 24.321 - - - - - -
Q5135 - Injection, tocilizumab-aazg (tyenne), biosimilar, 1 mg 1 MG 4.436 - - - - - -
Q5136 - Injection, denosumab-bbdz (jubbonti/wyost), biosimilar, 1 mg 1 MG 27.914 - - - - - -
Q5138 - Injection, ustekinumab-auub (wezlana), biosimilar, intravenous, 1 mg 1 MG 4.544 - - - - - -
Q5146 - Injection, trastuzumab-strf (hercessi), biosimilar, 10 mg 10 MG 37.865 - - - - - -
Q5147 - Injection, aflibercept-ayyh (pavblu), biosimilar, 1 mg 1 MG 821.396 - - - - - -
Q5148 - Injection, filgrastim-txid (nypozi), biosimilar, 1 microgram 1 MCG 1.028 - - - - - -
Q5151 - Injection, eculizumab-aagh (epysqli), biosimilar, 2 mg 2 MG 31.928 - - - - - -
Q5152 - Injection, eculizumab-aeeb (bkemv), biosimilar, 2 mg 2 MG 41.789 - - - - - -
Q5156 - Injection, tocilizumab-anoh (avtozma), biosimilar, 1 mg 1 MG 4.635 - - - - - -
Q5157 - Injection, denosumab-bmwo (stoboclo/osenvelt), biosimilar, 1 mg 1 MG 26.209 - - - - - -
Q5158 - Injection, denosumab-bnht (bomyntra/conexxence), biosimilar, 1 mg 1 MG 29.797 - - - - - -
Q5162 - Injection, denosumab-nxxp (bildyos/bilprevda), biosimilar, 1 mg 1 MG 15.841 - - - - - -
Q9950 - Injection, sulfur hexafluoride lipid microspheres, per ml 1 ML 18.12 - - - - - -
Q9956 - Injection, octafluoropropane microspheres, per ml 1 ML 39.956 - - - - - -
Q9957 - Injection, perflutren lipid microspheres, per ml 1 ML 39.956 - - - - - -
Q9958 - High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml 1 ML 0.076 - - - - - -
Q9961 - High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml 1 ML 0.262 - - - - - -
Q9963 - High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml 1 ML 0.218 - - - - - -
Q9965 - Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml 1 ML 1.155 - - - - - -
Q9966 - Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml 1 ML 0.434 - - - - - -
Q9967 - Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml 1 ML 0.154 - - - - - -
* Effective April 1, 2026 through June 30, 2026

ASP (Average Sale Price) Drug Pricing History