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 8 * 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
J0899 - Injection, argatroban (auromedics), not therapeutically equivalent to j0884, 1 mg (for esrd on dialysis) 1 MG 1.376 - - - - - -
J0901 - Vadadustat, oral, 1 mg (for esrd on dialysis) 1 MG 0.135 - - - - - -
J1000 - Injection, depo-estradiol cypionate, up to 5 mg 5 MG 51.82 - - - - - -
J1010 - Injection, methylprednisolone acetate, 1 mg 1 MG 0.112 - - - - - -
J1071 - Injection, testosterone cypionate, 1 mg 1 MG 0.024 - - - - - -
J1072 - Injection, testosterone cypionate (azmiro), 1 mg 1 MG 0.135 - - - - - -
J1096 - Dexamethasone, lacrimal ophthalmic insert, 0.1 mg 0.1 MG 92.547 - - - - - -
J1100 - Injection, dexamethasone sodium phosphate, 1 mg 1 MG 0.11 - - - - - -
J1110 - Injection, dihydroergotamine mesylate, per 1 mg 1 MG 54.885 - - - - - -
J1120 - Injection, acetazolamide sodium, up to 500 mg 500 MG 24.36 - - - - - -
J1160 - Injection, digoxin, up to 0.5 mg 0.5 MG 10.372 - - - - - -
J1162 - Injection, digoxin immune fab (ovine), per vial PER VIAL 5166.991 - - - - - -
J1163 - Injection, diltiazem hydrochloride, 0.5 mg 0.5 MG 0.04 - - - - - -
J1164 - Injection, diltiazem hydrochloride in 0.72% sodium chloride, 0.5 mg 0.5 MG 0.179 - - - - - -
J1165 - Injection, phenytoin sodium, per 50 mg 50 MG 0.421 - - - - - -
J1171 - Injection, hydromorphone, 0.1 mg 0.1 MG 0.101 - - - - - -
J1190 - Injection, dexrazoxane hydrochloride, per 250 mg 250 MG 49.738 - - - - - -
J1200 - Injection, diphenhydramine hcl, up to 50 mg 50 MG 0.687 - - - - - -
J1201 - Injection, cetirizine hydrochloride, 0.5 mg 0.5 MG 16.922 - - - - - -
J1203 - Injection, cipaglucosidase alfa-atga, 5 mg 5 MG 92.398 - - - - - -
J1205 - Injection, chlorothiazide sodium, per 500 mg 500 MG 46.921 - - - - - -
J1212 - Injection, dmso, dimethyl sulfoxide, 50%, 50 ml 50 ML 748.975 - - - - - -
J1230 - Injection, methadone hcl, up to 10 mg 10 MG 14.706 - - - - - -
J1240 - Injection, dimenhydrinate, up to 50 mg 50 MG 7.717 - - - - - -
J1245 - Injection, dipyridamole, per 10 mg 10 MG 8.41 - - - - - -
* Effective April 1, 2026 through June 30, 2026

ASP (Average Sale Price) Drug Pricing History