ASP Drug Pricing - (2nd Quarter)
April 2026
Payment Allowance Limits for Medicare Part B Drugs

  • Note 1: Payment allowance limits subject to the ASP methodology are based on Oct 2025 (4th 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 1 * Effective April 1, 2026 through June 30, 2026
HCPCS Code Code Dosage Payment
Limit		 Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
A9573 - Injection, gadopiclenol, 1 ml 1 ML 3.22 - - - - - -
A9575 - Injection, gadoterate meglumine, 0.1 ml 0.1 ML 0.09 - - - - - -
A9576 - Injection, gadoteridol, (prohance multipack), per ml 1 ML 1.391 - - - - - -
A9577 - Injection, gadobenate dimeglumine (multihance), per ml 1 ML 1.787 - - - - - -
A9578 - Injection, gadobenate dimeglumine (multihance multipack), per ml 1 ML 1.717 - - - - - -
A9579 - Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml 1 ML 1.449 - - - - - -
A9581 - Injection, gadoxetate disodium, 1 ml 1 ML 14.727 - - - - - -
A9585 - Injection, gadobutrol, 0.1 ml 0.1 ML 0.304 - - - - - -
A9589 - Instillation, hexaminolevulinate hydrochloride, 100 mg 100 MG 1424.121 - - - - - -
A9606 - Radium ra-223 dichloride, therapeutic, per microcurie 1 microCurie N/A - - - - - -
J0121 - Injection, omadacycline, 1 mg 1 MG 4.134 - - - - - -
J0122 - Injection, eravacycline, 1 mg 1 MG 1.288 - - - - - -
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 44.718 - - - - - -
J0131 - Injection, acetaminophen, not otherwise specified,10 mg 10 MG 0.051 - - - - - -
J0132 - Injection, acetylcysteine, 100 mg 100 MG 0.511 - - - - - -
J0133 - Injection, acyclovir, 5 mg 5 MG 0.017 - - - - - -
J0134 - Injection, acetaminophen (fresenius kabi), not therapeutically equivalent to j0131, 10 mg 10 MG 0.053 - - - - - -
J0136 - Injection, acetaminophen (b braun), not therapeutically equivalent to j0131, 10 mg 10 MG 0.05 - - - - - -
J0137 - Injection, acetaminophen (hikma), not therapeutically equivalent to j0131, 10 mg 10 MG 0.057 - - - - - -
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 0.48 - - - - - -
J0162 - Injection, epinephrine (fresenius), not therapeutically equivalent to j0165, 0.1 mg 0.1 MG 0.425 - - - - - -
J0163 - Injection, epinephrine in sodium chloride (endo), 0.1 mg 0.1 MG 0.3 - - - - - -
J0164 - Injection, epinephrine in sodium chloride (baxter), 0.1 mg 0.1 MG 0.924 - - - - - -
J0165 - Injection, epinephrine, not otherwise specified, 0.1 mg 0.1 MG 0.314 - - - - - -
* Effective April 1, 2026 through June 30, 2026

ASP (Average Sale Price) Drug Pricing History