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 6 * 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
J0593 - Injection, lanadelumab-flyo, 1 mg (code may be used for medicare when drug administered under direct supervision of a physician, not for use when drug is self-administered) 1 mg 87.190 - - - - - -
J0594 - injection, busulfan, 1 mg 1 MG 0.892 - - - - - -
J0595 - Injection, butorphanol tartrate, 1 mg 1 MG 5.544 - - - - - -
J0596 - Injection, c1 esterase inhibitor (recombinant), ruconest, 10 units 10 UNITS 36.778 - - - - - -
J0597 - Injection, c-1 esterase inhibitor (human), berinert, 10 units 10 UNITS 75.860 - - - - - -
J0598 - Injection, c-1 esterase inhibitor (human), cinryze, 10 units 10 UNITS 65.630 - - - - - -
J0600 - Injection, edetate calcium disodium, up to 1000 mg 1000 MG 6209.677 - - - - - -
J0612 - Injection, calcium gluconate, not otherwise specified, 10 mg 10 MG 0.030 - - - - - -
J0613 - Injection, calcium gluconate (wg critical care), not therapeutically equivalent to j0612, 10 mg 10 MG 0.087 - - - - - -
J0614 - Injection, treosulfan, 50 mg 50 MG 31.207 - - - - - -
J0616 - Injection, metoprolol tartrate, 1 mg 1 MG 0.119 - - - - - -
J0637 - Injection, caspofungin acetate, 5 mg 5 MG 3.818 - - - - - -
J0638 - Injection, canakinumab, 1 mg 1 MG 147.741 - - - - - -
J0640 - Injection, leucovorin calcium, per 50 mg 50 MG 3.840 - - - - - -
J0641 - Injection, levoleucovorin, not otherwise specified, 0.5 mg 0.5 MG 0.048 - - - - - -
J0642 - Injection, levoleucovorin (khapzory), 0.5 mg 0.5 MG 1.411 - - - - - -
J0650 - Injection, levothyroxine sodium, not otherwise specified, 10 mcg 10 MCG 5.983 - - - - - -
J0651 - Injection, levothyroxine sodium (fresenius kabi), not therapeutically equivalent to j0650, 10 mcg 10 MCG 6.936 - - - - - -
J0652 - Injection, levothyroxine sodium (hikma), not therapeutically equivalent to j0650, 10 mcg 10 MCG 7.686 - - - - - -
J0665 - Injection, bupivicaine, not otherwise specified, 0.5 mg 0.5 MG 0.011 - - - - - -
J0666 - Injection, bupivacaine liposome, 1 mg 1 MG 1.438 - - - - - -
J0670 - Injection, mepivacaine hydrochloride, per 10 ml 10 ML 3.750 - - - - - -
J0687 - Injection, cefazolin sodium (wg critical care), not therapeutically equivalent to j0690, 500 mg 500 MG 0.879 - - - - - -
J0688 - Injection, cefazolin sodium (hikma), not therapeutically equivalent to j0690, 500 mg 500 MG 0.875 - - - - - -
J0689 - Injection, cefazolin sodium (baxter), not therapeutically equivalent to j0690, 500 mg 500 MG 1.272 - - - - - -
* Effective January 1, 2026 through March 31, 2026

ASP (Average Sale Price) Drug Pricing History