Medicare Part B Drug Payment Limit Lookup
Medicare does not price an injectable drug under the Physician Fee Schedule. It publishes a separate quarterly file of Part B payment allowance limits, one national amount per HCPCS code, and every amount is per dosage unit. Type a J, Q, A9, P9 or vaccine code and a date of service below and this tool answers from the file in force that day, unit included.
One national limit, per dosage unit, per date of service
Results
J1885. New York, date of service Oct 1, 2026.
The release behind these figures
Every amount above is computed from the CMS file below, held in a pinned archive so a number printed in a report can be produced again later, unchanged. The date of service chooses the file. Archive last rebuilt Oct 5, 2026.
- Release
- pfs-2026-10
- CMS file
- 2026 October (quarterly MPFSDB update, CR 14588)
- Prices dates of service
- Oct 1, 2026 onward
- Conversion factor
- $33.40
All 17 CMS physician releases in this archive
Source & method
- Amounts: the CMS Medicare Part B drug payment limit file, every quarterly release from January 2023 to October 2026. A date of service is priced under the file CMS had in force that day. The figures on this page come from the October 2026 ASP / Part B payment limits, final file (CR 14521) release, read from section 508 version of October 2026 Medicare Part B Payment Limit File 091626.csv inside the archived CMS file october-2026-medicare-part-b-payment-limit-files-final.zip (sha256 a9b7afa80aae96c4). That file’s own preamble reads “Effective October 1, 2026 through December 31, 2026”, and its first note names 2026Q2 as the ASP data quarter behind the limits subject to that methodology.
- Units: every published limit is per HCPCS dosage unit and no figure is shown without it. CMS re-bases units between quarters, so a figure lifted from one release into another loses its meaning.
- Precision: amounts are carried as whole thousandths of a dollar, exactly as CMS publishes them to three decimals, and divided only when displayed. Nothing rounds to cents in transit.
- What is not claimed: CMS’s preamble makes no statement about how a payment limit is arrived at, so neither does this site. The figure shown is the limit CMS published for that code in that quarter, and nothing here describes the method behind it.
- CMS document for this release: October 2026 ASP / Part B payment limits, final file (CR 14521). CMS ASP pricing files.
Medicare Part B drug limits, explained
What is the Medicare Part B drug payment limit file?
It is the quarterly CMS file that carries one payment allowance limit per Part B drug HCPCS code. The October 2026 ASP / Part B payment limits, final file (CR 14521) release lists 918 codes, of which 917 carry a published limit. It is not only J codes: the file also carries 90xxx and 91xxx vaccine codes, A9xxx items, P90xx blood products and Q codes. Every figure on this page is read directly from that file.
An amount and its dosage unit are one fact
Every limit CMS publishes is per HCPCS dosage unit, and the unit is not stable between quarters. J2404, Inj, nicardipine 0.1 mg, is the case that proves it. The October 2024 ASP / Part B payment limits (CR 13679) file gives $0.539 per 1 MG. The January 2025 ASP / Part B payment limits (CR 13802) file gives $0.077 per 0.1 MG. Compared as bare numbers that reads as a steep fall. Put on the same unit, the later limit is $0.770 per 1 MG, so the price per milligram went up rather than collapsing. What changed is the unit. A report that carried the October figure under the January unit would be wrong by a factor of ten on every line.
Two codes in this file really are priced per vial rather than per milligram, and CMS says so in the unit column, so “per vial” is not always a transcription error. The only safe rule is to carry the unit with the number, every time.
What Medicare publishes for common Part B drugs
The table below lists October 2026 limits for 8 drugs that appear on injury and treatment bills, beside the July 2026 limit for the same code. 8 of the 8 changed between those two quarters. Each figure is per the dosage unit shown, and applies in every state.
| Code | Drug | Unit | October 2026 | July 2026 |
|---|---|---|---|---|
| J1885 | Ketorolac tromethamine inj | 15 MG | $0.569 per 15 MG | $0.286 per 15 MG |
| J3301 | Triamcinolone acet inj nos | 10 MG | $0.787 per 10 MG | $0.996 per 10 MG |
| J1100 | Dexamethasone sodium phos | 1 MG | $0.099 per 1 MG | $0.085 per 1 MG |
| J0696 | Ceftriaxone sodium injection | 250 MG | $0.390 per 250 MG | $0.404 per 250 MG |
| J2405 | Ondansetron hcl injection | 1 MG | $0.084 per 1 MG | $0.088 per 1 MG |
| J7325 | Synvisc or synvisc-one | 1 MG | $6.011 per 1 MG | $6.018 per 1 MG |
| J0585 | Injection,onabotulinumtoxina | 1 UNIT | $6.514 per 1 UNIT | $6.506 per 1 UNIT |
| J1071 | Inj testosterone cypionate | 1 MG | $0.023 per 1 MG | $0.025 per 1 MG |
Source: CMS Medicare Part B payment limit files, October 2026 ASP / Part B payment limits, final file (CR 14521) (october-2026-medicare-part-b-payment-limit-files-final.zip) and July 2026 ASP / Part B payment limits (CR 14422) (july-2026-medicare-part-b-payment-limit-files.zip). Amounts are shown to the three decimals CMS publishes.
Why the quarter matters more here than on any other schedule
Because most of the file is repriced every quarter. CMS changed the published limit on 800 of the 880 codes carried in both the July 2026 ASP / Part B payment limits (CR 14422) and October 2026 ASP / Part B payment limits, final file (CR 14521) releases, leaving only 80 untouched. Across the whole archive, January 2023 to October 2026, 9,276 amounts change in an April, July or October release. Pricing a drug line against January’s file for a date of service in August is therefore the wrong figure far more often than it is the right one, which is why a date of service, and not a year, selects the file.
When CMS publishes no limit at all
“N/A” in the Payment Limit column is a real published value with CMS’s own reason beside it, and it never means zero. In the October 2026 ASP / Part B payment limits, final file (CR 14521) file it applies to A9606, Radium ra223 dichloride ther. Codes also move out of that state: J0739, J0750, J0751 carried no limit in the October 2024 ASP / Part B payment limits (CR 13679) file, where CMS’s note read “The payment allowance for this code will be determined by the MAC processing the claim.”, and each had a published limit by January 2025 ASP / Part B payment limits (CR 13802) (J0739 at $6.892 per 1 mg, J0750 at $1.817 per 200 mg/300 mg, J0751 at $71.289 per 200 mg/25 mg).
CMS Notes for A9606, per 1 microCurie: microCurie 100% AWP = $212.84 microCurie 100% WAC = $177.37
Key terms on a Part B drug pricing row
- Payment allowance limit
- The single national figure CMS publishes for the code in that quarter. It does not vary by state or locality.
- HCPCS dosage unit
- What the amount is measured per: “1 MG”, “0.1 MG”, “1 UNIT”, “PER VIAL”. It belongs to the amount and CMS re-bases it between quarters.
- N/A
- CMS publishes no limit for that code in that file, with its reason in the Notes column. Not zero, and not a gap in the data.
- Notes
- CMS’s own text for the row, carried verbatim. Several notes say the figure in this file is not the current one for that drug, which is a limitation that belongs beside the number rather than behind it.
- Preliminary file
- CMS posts a preliminary file for a quarter before the final one. Nothing inside the file says which it is, only the download name does, so anything priced from one has to say so.
- Release
- One quarterly issue of the file, such as October 2026 ASP / Part B payment limits, final file (CR 14521). The release in force on the date of service is the one that prices the line, and July 2026 ASP / Part B payment limits (CR 14422) is the one before it.
How bill reviewers use Part B drug limits
Medical billing experts use the published limit to test whether a drug charge is reasonable. The workflow is to read the HCPCS code and the units billed off the claim, price the code under the file CMS had in force on the date of service, multiply by the units in the code’s own dosage terms, and set the total beside the billed charge. The two failure modes are both about the unit: multiplying a per-milligram limit by a count of vials, and carrying a limit from a quarter whose unit was different. For the professional and facility codes on the same bill, use the Medicare rate lookup. For laboratory lines, see the clinical lab fee schedule. For New Jersey no-fault claims, the state schedule is in the NJ PIP fee schedule lookup. For the full workflow from a stack of bills to a signed report, see Desk.
Medicare Part B drug pricing, answered
What is the Medicare Part B drug payment limit file?
It is the separate CMS file that carries a payment allowance limit for each Part B drug HCPCS code, and it is what a drug line on a bill is benchmarked against rather than the Physician Fee Schedule. The October 2026 ASP / Part B payment limits, final file (CR 14521) file carries 918 codes, 917 of them with a published limit. CMS reissues it every quarter, and this archive holds all 16 releases from January 2023 to October 2026.
Is a Medicare Part B drug payment limit different in different states?
No. Like the clinical laboratory schedule, this file has no geography: one national amount per code, the same everywhere. What it does have, and what the lab schedule does not, is a dosage unit that belongs to each amount. So a lookup asks for a code and a date of service, and what comes back is an amount and the unit it is measured in.
Why must a Part B drug amount always be quoted with its dosage unit?
Because the amount means nothing without it, and CMS re-bases units between quarters. J2404, Inj, nicardipine 0.1 mg, is $0.539 per 1 MG in the October 2024 ASP / Part B payment limits (CR 13679) file and $0.077 per 0.1 MG in the January 2025 ASP / Part B payment limits (CR 13802) file. Read as bare numbers that looks like a collapse in price. Put on the same unit, the later limit is $0.770 per 1 MG, so the amount per milligram actually rose while the unit shrank. Carrying the wrong quarter's unit into a report misstates the line by a factor of ten.
Does the Medicare Part B drug file change during the year?
More than any other Medicare schedule on this site. Between the July 2026 ASP / Part B payment limits (CR 14422) and October 2026 ASP / Part B payment limits, final file (CR 14521) releases, CMS changed the published limit on 800 of the 880 codes that appear in both, leaving only 80 unchanged. Across the whole archive, 9,276 amounts change in an April, July or October release. A January figure is simply the wrong figure for most codes for three quarters of the year.
What does "N/A" mean in the Medicare Part B payment limit column?
It is a real published value and not a missing one, and it never means zero. CMS writes "N/A" where it publishes no limit and puts its reason in the Notes column beside it. In the October 2026 ASP / Part B payment limits, final file (CR 14521) file one code carries it: A9606, Radium ra223 dichloride ther. Codes move in and out of that state: J0739, J0750, J0751 carried no limit in the October 2024 ASP / Part B payment limits (CR 13679) file and had one by January 2025 ASP / Part B payment limits (CR 13802). The honest answer for such a code is that CMS published no limit for that date, with CMS's own note as the reason.
Does this file say whether Medicare covers a drug?
No, and CMS says so in the file itself. Its own note reads: "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." So the presence of a code here is not a coverage opinion, and neither is its absence.
How precise are the published amounts?
CMS publishes three decimal places, and the third one is load-bearing: several codes are priced in fractions of a cent per unit, so rounding to cents before multiplying by the units billed changes the answer. Amounts are carried here as whole thousandths and divided only at the point of display, so no rounding happens in transit.