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 3 * 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
J0136 - Injection, acetaminophen (b braun), not therapeutically equivalent to j0131, 10 mg 10 MG 0.051 - - - - - -
J0137 - Injection, acetaminophen (hikma), not therapeutically equivalent to j0131, 10 mg 10 MG 0.053 - - - - - -
J0138 - Injection, acetaminophen 10 mg and ibuprofen 3 mg 10 MG/3MG 0.092 - - - - - -
J0153 - Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds) 1 MG 0.529 - - - - - -
J0162 - Injection, epinephrine (fresenius), not therapeutically equivalent to j0165, 0.1 mg 0.1 MG 0.455 - - - - - -
J0163 - Injection, epinephrine in sodium chloride (endo), 0.1 mg 0.1 MG 0.878 - - - - - -
J0164 - Injection, epinephrine in sodium chloride (baxter), 0.1 mg 0.1 MG 0.941 - - - - - -
J0165 - Injection, epinephrine, not otherwise specified, 0.1 mg 0.1 MG 0.433 - - - - - -
J0166 - Injection, epinephrine (bpi), not therapeutically equivalent to j0165, 0.1 mg 0.1 MG 1.106 - - - - - -
J0167 - Injection, epinephrine (hospira), not therapeutically equivalent to j0165, 0.1 mg 0.1 MG 1.422 - - - - - -
J0168 - Injection, epinephrine (international medication systems), not therapeutically equivalent to j0165, 0.1 mg 0.1 MG 2.998 - - - - - -
J0169 - Injection, epinephrine (adrenalin), not therapeutically equivalent to j0165, 0.1 mg 0.1 MG 1.383 - - - - - -
J0174 - Lecanemab-irmb, for intravenous injection, 1 mg 1 MG 1.330 - - - - - -
J0175 - Injection, donanemab-azbt, 2 mg 2 MG 4.166 - - - - - -
J0177 - Injection, aflibercept hd, 1 mg 1 MG 306.985 - - - - - -
J0178 - Injection, aflibercept, 1 mg 1 MG 763.901 - - - - - -
J0179 - Injection, brolucizumab-dbll, 1 mg 1 MG 352.813 - - - - - -
J0180 - Injection, agalsidase beta, 1 mg 1 MG 230.319 - - - - - -
J0185 - Injection, aprepitant, 1 mg 1 MG 1.713 - - - - - -
J0202 - Injection, alemtuzumab, 1 mg 1 MG 2447.102 - - - - - -
J0206 - Injection, allopurinol sodium, 1 mg 1 MG 4.403 - - - - - -
J0217 - Injection, velmanase alfa-tycv, 1 mg 1 MG 465.234 - - - - - -
J0218 - Injection, olipudase alfa-rpcp, 1 mg 1 MG 395.520 - - - - - -
J0219 - Injection, avalglucosidase alfa-ngpt, 4 mg 4 MG 81.296 - - - - - -
J0221 - Injection, alglucosidase alfa, (lumizyme), 10 mg 10 MG 207.385 - - - - - -
* Effective January 1, 2026 through March 31, 2026

ASP (Average Sale Price) Drug Pricing History