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 5 * 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
J0461 - Injection, atropine sulfate, 0.01 mg 0.01 MG 0.104 - - - - - -
J0462 - Injection, atropine sulfate, not therapeutically equivalent to j0461, 0.01 mg 0.01 MG 0.133 - - - - - -
J0475 - Injection, baclofen, 10 mg 10 MG 181.466 - - - - - -
J0476 - Injection, baclofen, 50 mcg for intrathecal trial 50 MCG 59.514 - - - - - -
J0480 - Injection, basiliximab, 20 mg 20 MG 4781.073 - - - - - -
J0485 - Injection, belatacept, 1 mg 1 MG 3.892 - - - - - -
J0490 - Injection, belimumab, 10 mg 10 MG 57.156 - - - - - -
J0491 - Injection, anifrolumab-fnia, 1 mg 1 MG 18.338 - - - - - -
J0500 - Injection, dicyclomine hcl, up to 20 mg 20 MG 11.327 - - - - - -
J0515 - Injection, benztropine mesylate, per 1 mg 1 MG 13.815 - - - - - -
J0517 - Injection, benralizumab, 1 mg 1 MG 163.965 - - - - - -
J0558 - Injection, penicillin g benzathine and penicillin g procaine, 100,000 units 100,000 UNITS 19.523 - - - - - -
J0561 - Injection, penicillin g benzathine, 100,000 units 100,000 UNITS 31.965 - - - - - -
J0565 - Injection, bezlotoxumab, 10 mg 10 MG 39.825 - - - - - -
J0577 - Injection, buprenorphine extended-release (brixadi), less than or equal to 7 days of therapy Less than or equal to 7 days of therapy 420.053 - - - - - -
J0578 - Injection, buprenorphine extended release (brixadi), greater than 7 days and up to 28 days of therapy Greater than 7 days and up to 28 days of therapy 1680.211 - - - - - -
J0582 - Injection, bivalirudin (endo), not therapeutically equivalent to j0583, 1 mg 1 MG 0.143 - - - - - -
J0583 - Injection, bivalirudin, 1 mg 1 MG 0.157 - - - - - -
J0584 - Injection, burosumab-twza 1 mg 1 MG 498.017 - - - - - -
J0585 - Injection, onabotulinumtoxina, 1 unit 1 UNIT 6.510 - - - - - -
J0586 - Injection, abobotulinumtoxina, 5 units 5 Unit 8.799 - - - - - -
J0587 - Injection, rimabotulinumtoxinb, 100 units 100 UNITS 13.289 - - - - - -
J0588 - Injection, incobotulinumtoxin a, 1 unit 1 UNIT 5.254 - - - - - -
J0589 - Injection, daxibotulinumtoxina-lanm, 1 unit 1 UNIT 3.114 - - - - - -
J0592 - Injection, buprenorphine hydrochloride, 0.1 mg 0.1 MG 4.212 - - - - - -
* Effective January 1, 2026 through March 31, 2026

ASP (Average Sale Price) Drug Pricing History