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 22 * 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
J7205 - Injection, factor viii fc fusion protein (recombinant), per iu 1 IU 2.578 - - - - - - 1
J7207 - Injection, factor viii, (antihemophilic factor, recombinant), pegylated, 1 i.u. 1 IU 2.119 - - - - - - 1
J7208 - Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl, (jivi), 1 i.u. 1 IU 2.756 - - - - - - 1
J7209 - Injection, factor viii, (antihemophilic factor, recombinant), (nuwiq), 1 i.u. 1 IU 1.221 - - - - - - 1
J7210 - Injection, factor viii, (antihemophilic factor, recombinant), (afstyla), 1 i.u. 1 IU 1.619 - - - - - - 1
J7211 - Injection, factor viii, (antihemophilic factor, recombinant), (kovaltry), 1 i.u. 1 IU 1.595 - - - - - - 1
J7212 - Factor viia (antihemophilic factor, recombinant)-jncw (sevenfact), 1 microgram 1 MCG 2.194 - - - - - - 1
J7213 - Injection, coagulation factor ix (recombinant), ixinity, 1 i.u. 1 IU 1.939 - - - - - - 1
J7214 - Injection, factor viii/von willebrand factor complex, recombinant (altuviiio), per factor viii i.u. 1 IU 4.632 - - - - - - 1
J7308 - Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg) 354 MG 389.28 - - - - - -
J7311 - Injection, fluocinolone acetonide, intravitreal implant (retisert), 0.01 mg 0.01 MG 338.804 - - - - - -
J7312 - Injection, dexamethasone, intravitreal implant, 0.1 mg 0.1 MG 203.656 - - - - - -
J7313 - Injection, fluocinolone acetonide, intravitreal implant (iluvien), 0.01 mg 0.01 MG 516.406 - - - - - -
J7318 - Hyaluronan or derivative, durolane, for intra-articular injection, 1 mg 1 MG 6.239 - - - - - -
J7320 - Hyaluronan or derivitive, genvisc 850, for intra-articular injection, 1 mg 1 MG 3.808 - - - - - -
J7321 - Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose per dose 70.282 - - - - - -
J7322 - Hyaluronan or derivative, hymovis or hymovis one, for intra-articular injection, 1 mg 1 MG 18.131 - - - - - -
J7323 - Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose per dose 98.137 - - - - - -
J7324 - Hyaluronan or derivative, orthovisc, for intra-articular injection, per dose PER DOSE 100.331 - - - - - -
J7325 - Hyaluronan or derivative, synvisc or synvisc-one, for intra-articular injection, 1 mg 1 MG 6.018 - - - - - -
J7326 - Hyaluronan or derivative, gel-one, for intra-articular injection, per dose per dose 533.592 - - - - - -
J7327 - Hyaluronan or derivative, monovisc, for intra-articular injection, per dose PER DOSE 565.275 - - - - - -
J7328 - Hyaluronan or derivative, gelsyn-3, for intra-articular injection, 0.1 mg 0.1 MG 0.584 - - - - - -
J7329 - Hyaluronan or derivative, trivisc, for intra-articular injection, 1 mg 1 MG 3.036 - - - - - -
J7331 - Hyaluronan or derivative, synojoynt, for intra-articular injection, 1 mg 1 MG 3.115 - - - - - -
* Effective Jul 1, 2026 through Sep 30, 2026

ASP (Average Sale Price) Drug Pricing History