ASP Drug Pricing - (3rd Quarter)
July 2026
Payment Allowance Limits for Medicare Part B Drugs

  • Note 1: Payment allowance limits subject to the ASP methodology are based on Jan 2026 (1st 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 Jul 1, 2026 through Sep 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 1.596 - - - - - -
J3415 - Injection, pyridoxine hcl, 100 mg 100 MG 12.941 - - - - - -
J3420 - Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg 1000 MCG 0.683 - - - - - -
J3425 - Injection, hydroxocobalamin, intramuscular, 10 mcg 10 MCG 0.007 - - - - - -
J3430 - Injection, phytonadione (vitamin k), per 1 mg 1 MG 3.253 - - - - - -
J3465 - Injection, voriconazole, 10 mg 10 MG 0.563 - - - - - -
J3470 - Injection, hyaluronidase, up to 150 units 150 UNITS 31.764 - - - - - -
J3473 - Injection, hyaluronidase, recombinant, 1 usp unit 1 USP UNIT 0.364 - - - - - -
J3475 - Injection, magnesium sulfate, per 500 mg 500 MG 0.446 - - - - - -
J3480 - Injection, potassium chloride, per 2 meq 2 MEQ 0.136 - - - - - -
J3485 - Injection, zidovudine, 10 mg 10 MG 1.513 - - - - - -
J3486 - Injection, ziprasidone mesylate, 10 mg 10 MG 5.602 - - - - - -
J3489 - Injection, zoledronic acid, 1 mg 1 MG 3.361 - - - - - -
J7030 - Infusion, normal saline solution , 1000 cc 1000 CC 2.181 - - - - - -
J7040 - Infusion, normal saline solution, sterile (500 ml = 1 unit) 500 ML 1.35 - - - - - -
J7042 - 5% dextrose/normal saline (500 ml = 1 unit) 500 ML 1.215 - - - - - -
J7050 - Infusion, normal saline solution, 250 cc 250 CC 0.703 - - - - - -
J7060 - 5% dextrose/water (500 ml = 1 unit) 500 ML 1.649 - - - - - -
J7070 - Infusion, d5w, 1000 cc 1000 CC 2.847 - - - - - -
J7120 - Ringers lactate infusion, up to 1000 cc 1000 CC 2.313 - - - - - -
J7170 - Injection, emicizumab-kxwh, 0.5 mg 0.5 MG 58.032 - - - - - - 1
J7171 - Injection, adamts13, recombinant-krhn, 10 iu 10 UNITS 36.214 - - - - - -
J7172 - Injection, marstacimab-hncq, 0.5 mg 0.5 MG 51.191 - - - - - - 1
J7173 - Injection, concizumab-mtci, 0.5 mg 0.5 MG 86.158 - - - - - - 1
J7174 - Injection, fitusiran, 0.04 mg 0.04 MG 131.202 - - - - - - 1
* Effective Jul 1, 2026 through Sep 30, 2026

ASP (Average Sale Price) Drug Pricing History