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 7 * 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
J0791 - Injection, crizanlizumab-tmca, 5 mg 5 MG 129.944 - - - - - -
J0801 - Injection, corticotropin (acthar gel), up to 40 units 40 UNITS 4094.259 - - - - - -
J0802 - Injection, corticotropin (ani), up to 40 units up to 40 Units 3571.351 - - - - - -
J0834 - Injection, cosyntropin, 0.25 mg 0.25 MG 16.258 - - - - - -
J0840 - Injection, crotalidae polyvalent immune fab (ovine), up to 1 gram UP TO 1 GM 1841.019 - - - - - -
J0850 - Injection, cytomegalovirus immune globulin intravenous (human), per vial PER VIAL 1808.607 - - - - - -
J0870 - Injection, imetelstat, 1 mg 1 MG 58.169 - - - - - -
J0872 - Injection, daptomycin (xellia), unrefrigerated, not therapeutically equivalent to j0878 or j0873, 1 mg 1 MG 0.054 - - - - - -
J0873 - Injection, daptomycin (xellia), not therapeutically equivalent to j0878 or j0872, 1 mg 1 MG 0.026 - - - - - -
J0874 - Injection, daptomycin (baxter), not therapeutically equivalent to j0878, 1 mg 1 MG 0.057 - - - - - -
J0875 - Injection, dalbavancin, 5 mg 5 MG 15.003 - - - - - -
J0877 - Injection, daptomycin (hospira), not therapeutically equivalent to j0878, 1 mg 1 MG 0.054 - - - - - -
J0878 - Injection, daptomycin, 1 mg 1 MG 0.034 - - - - - -
J0881 - Injection, darbepoetin alfa, 1 microgram (non-esrd use) 1 MCG 3.072 - - - - - -
J0882 - Injection, darbepoetin alfa, 1 microgram (for esrd on dialysis) 1 MCG 3.072 - - - - - -
J0883 - Injection, argatroban, 1 mg (for non-esrd use) 1 MG 1.013 - - - - - -
J0884 - Injection, argatroban, 1 mg (for esrd on dialysis) 1 MG 1.013 - - - - - -
J0885 - Injection, epoetin alfa, (for non-esrd use), 1000 units 1000 UNITS 7.305 - - - - - -
J0887 - Injection, epoetin beta, 1 microgram, (for esrd on dialysis) 1 MCG 1.033 - - - - - -
J0888 - Injection, epoetin beta, 1 microgram, (for non esrd use) 1 MCG 1.033 - - - - - -
J0894 - Injection, decitabine, 1 mg 1 MG 1.001 - - - - - -
J0895 - Injection, deferoxamine mesylate, 500 mg 500 MG 8.577 - - - - - -
J0896 - Injection, luspatercept-aamt, 0.25 mg 0.25 MG 42.75 - - - - - -
J0897 - Injection, denosumab, 1 mg 1 MG 29.507 - - - - - -
J0898 - Injection, argatroban (auromedics), not therapeutically equivalent to j0883, 1 mg (for non-esrd use) 1 MG 1.376 - - - - - -
* Effective April 1, 2026 through June 30, 2026

ASP (Average Sale Price) Drug Pricing History