ASP Drug Pricing - (1st Quarter)
January 2026
Payment Allowance Limits for Medicare Part B Drugs

  • Note 1: Payment allowance limits subject to the ASP methodology are based on Jul 2025 (3nd Quarter) ASP data.
  • Note 2: The absence or presence of a HCPCS code and the payment allowance limits in this table does not indicate whether Medicare covers a drug. These determinations shall be made by the local Medicare contractor processing the claim.
 
Page 2 * Effective January 1, 2026 through March 31, 2026
HCPCS Code Code Dosage Payment
Limit		 Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
90747 - Hepb vacc 4 dose immunsup im 40 MCG 164.422 95% 164.422 - - - -
90759 - Hep b vac 3ag 10mcg 3 dos im 10 MCG 73.815 95% 73.815 - - - -
91304 - SARSCOV2 VAC 5MCG/0.5ML IM 0.5 ML 191.919 95% 191.919 - - - -
91319 - SARSCV2 VAC 10MCG TRS-SUC IM 0.3 ML 94.802 95% 94.802 - - - -
91320 - SARSCV2 VAC 30MCG TRS-SUC IM 0.3 ML 168.367 95% 168.367 - - - -
91321 - SARSCOV2 VAC 25 MCG/.25ML IM 0.25 ML 147.060 95% 147.060 - - - -
91322 - SARSCOV2 VAC 50 MCG/0.5ML IM 0.5 ML 161.652 95% 161.652 - - - -
91323 - SARSCOV2 VAC 10 MCG/0.2ML IM 10 MCG 201.913 95% 201.913 - - - -
A9573 - Injection, gadopiclenol, 1 ml 1 ML 3.298 - - - - - -
A9575 - Injection, gadoterate meglumine, 0.1 ml 0.1 ML 0.103 - - - - - -
A9576 - Injection, gadoteridol, (prohance multipack), per ml 1 ML 1.415 - - - - - -
A9577 - Injection, gadobenate dimeglumine (multihance), per ml 1 ML 1.799 - - - - - -
A9578 - Injection, gadobenate dimeglumine (multihance multipack), per ml 1 ML 1.758 - - - - - -
A9579 - Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml 1 ML 1.462 - - - - - -
A9581 - Injection, gadoxetate disodium, 1 ml 1 ML 14.753 - - - - - -
A9585 - Injection, gadobutrol, 0.1 ml 0.1 ML 0.275 - - - - - -
A9589 - Instillation, hexaminolevulinate hydrochloride, 100 mg 100 MG 1424.767 - - - - - -
A9606 - Radium ra-223 dichloride, therapeutic, per microcurie 1 microCurie N/A - - - - - -
J0121 - Injection, omadacycline, 1 mg 1 MG 4.137 - - - - - -
J0122 - Injection, eravacycline, 1 mg 1 MG 1.292 - - - - - -
J0129 - Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) 10 MG 44.769 - - - - - -
J0131 - Injection, acetaminophen, not otherwise specified,10 mg 10 MG 0.056 - - - - - -
J0132 - Injection, acetylcysteine, 100 mg 100 MG 0.367 - - - - - -
J0133 - Injection, acyclovir, 5 mg 5 MG 0.119 - - - - - -
J0134 - Injection, acetaminophen (fresenius kabi), not therapeutically equivalent to j0131, 10 mg 10 MG 0.056 - - - - - -
* Effective January 1, 2026 through March 31, 2026

ASP (Average Sale Price) Drug Pricing History