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 5 * 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
J0612 - Injection, calcium gluconate, not otherwise specified, 10 mg 10 MG 0.028 - - - - - -
J0613 - Injection, calcium gluconate (wg critical care), not therapeutically equivalent to j0612, 10 mg 10 MG 0.07 - - - - - -
J0614 - Injection, treosulfan, 50 mg 50 MG 31.608 - - - - - -
J0616 - Injection, metoprolol tartrate, 1 mg 1 MG 0.125 - - - - - -
J0637 - Injection, caspofungin acetate, 5 mg 5 MG 3.575 - - - - - -
J0638 - Injection, canakinumab, 1 mg 1 MG 149.574 - - - - - -
J0640 - Injection, leucovorin calcium, per 50 mg 50 MG 3.591 - - - - - -
J0641 - Injection, levoleucovorin, not otherwise specified, 0.5 mg 0.5 MG 0.052 - - - - - -
J0642 - Injection, levoleucovorin (khapzory), 0.5 mg 0.5 MG 1.293 - - - - - -
J0650 - Injection, levothyroxine sodium, not otherwise specified, 10 mcg 10 MCG 7.411 - - - - - -
J0651 - Injection, levothyroxine sodium (fresenius kabi), not therapeutically equivalent to j0650, 10 mcg 10 MCG 6.959 - - - - - -
J0652 - Injection, levothyroxine sodium (hikma), not therapeutically equivalent to j0650, 10 mcg 10 MCG 6.315 - - - - - -
J0665 - Injection, bupivicaine, not otherwise specified, 0.5 mg 0.5 MG 0.01 - - - - - -
J0666 - Injection, bupivacaine liposome, 1 mg 1 MG 1.409 - - - - - -
J0670 - Injection, mepivacaine hydrochloride, per 10 ml 10 ML 3.731 - - - - - -
J0687 - Injection, cefazolin sodium (wg critical care), not therapeutically equivalent to j0690, 500 mg 500 MG 0.736 - - - - - -
J0688 - Injection, cefazolin sodium (hikma), not therapeutically equivalent to j0690, 500 mg 500 MG 0.85 - - - - - -
J0689 - Injection, cefazolin sodium (baxter), not therapeutically equivalent to j0690, 500 mg 500 MG 1.237 - - - - - -
J0690 - Injection, cefazolin sodium, 500 mg 500 MG 0.845 - - - - - -
J0692 - Injection, cefepime hydrochloride, 500 mg 500 MG 1.268 - - - - - -
J0694 - Injection, cefoxitin sodium, 1 gm 1 GM 3.559 - - - - - -
J0695 - Injection, ceftolozane 50 mg and tazobactam 25 mg 75mg (50mg cft/25mg taz) 8.836 - - - - - -
J0696 - Injection, ceftriaxone sodium, per 250 mg 250 MG 0.43 - - - - - -
J0697 - Injection, sterile cefuroxime sodium, per 750 mg 750 MG 1.992 - - - - - -
J0699 - Injection, cefiderocol, 10 mg 10 mg 2.419 - - - - - -
* Effective April 1, 2026 through June 30, 2026

ASP (Average Sale Price) Drug Pricing History