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 3 * 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
J0280 - Injection, aminophyllin, up to 250 mg 250 MG 11.325 - - - - - -
J0281 - Injection, aminocaproic acid, 1 gram 1 GM 1.567 - - - - - -
J0282 - Injection, amiodarone hydrochloride, 30 mg 30 MG 0.389 - - - - - -
J0283 - Injection, amiodarone hydrochloride (nexterone), 30 mg 30 MG 2.488 - - - - - -
J0285 - Injection, amphotericin b, 50 mg 50 MG 44.331 - - - - - -
J0289 - Injection, amphotericin b liposome, 10 mg 10 MG 22.807 - - - - - -
J0290 - Injection, ampicillin sodium, 500 mg 500 MG 0.642 - - - - - -
J0291 - Injection, plazomicin, 5 mg 5 MG 3.508 - - - - - -
J0295 - Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm 1.5 GM 1.352 - - - - - -
J0348 - Injection, anidulafungin, 1 mg 1 MG 0.487 - - - - - -
J0349 - Injection, rezafungin, 1 mg 1 MG 10.787 - - - - - -
J0360 - Injection, hydralazine hcl, up to 20 mg 20 MG 4.288 - - - - - -
J0401 - Injection, aripiprazole (abilify maintena), 1 mg 1 MG 7.271 - - - - - -
J0402 - Injection, aripiprazole (abilify asimtufii), 1 mg 1 MG 6.022 - - - - - -
J0456 - Injection, azithromycin, 500 mg 500 MG 1.944 - - - - - -
J0457 - Injection, aztreonam, 100 mg 100 MG 2.288 - - - - - -
J0458 - Injection, aztreonam/avibactam, 7.5 mg/2.5 mg (10 mg) 10 MG 1.675 - - - - - -
J0461 - Injection, atropine sulfate, 0.01 mg 0.01 MG 0.102 - - - - - -
J0462 - Injection, atropine sulfate, not therapeutically equivalent to j0461, 0.01 mg 0.01 MG 0.103 - - - - - -
J0463 - Injection, atropine sulfate (fresenius and therapeutically equivalent), 0.01 mg 0.01 MG 0.014 - - - - - -
J0475 - Injection, baclofen, 10 mg 10 MG 178.052 - - - - - -
J0476 - Injection, baclofen, 50 mcg for intrathecal trial 50 MCG 54.338 - - - - - -
J0480 - Injection, basiliximab, 20 mg 20 MG 4812.313 - - - - - -
J0485 - Injection, belatacept, 1 mg 1 MG 3.893 - - - - - -
J0490 - Injection, belimumab, 10 mg 10 MG 57.189 - - - - - -
* Effective April 1, 2026 through June 30, 2026

ASP (Average Sale Price) Drug Pricing History