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ASP pricing file: October 2026 Part B drug payment limits

Every quarter CMS publishes the payment allowance limits for drugs and biologicals paid under Medicare Part B, together with crosswalks that tie each drug product's NDC to its HCPCS billing code. This page explains what the October 2026 release contains, how a limit is set and converted into billing units, and what each companion file is for. The per-code limits, NDC billing units and quarter-over-quarter changes are on the HCPCS drug code pages.

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: ASP payment limits: October 2026 (effective October 1, 2026); ASP NDC-HCPCS crosswalk: October 2026 (effective October 1, 2026); ASP companion files (AWP and PrEP crosswalks; not-payable list): October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update).

TL;DR

The October 2026 ASP pricing file sets Medicare Part B payment limits for 918 HCPCS codes from October 1 through December 31, 2026, based on second-quarter 2026 sales data. Most limits are 106% of the manufacturer-reported average sales price per billing unit; the companion crosswalk maps 7,222 NDCs to 877 codes so that units can be converted from the package actually used.

The October 2026 release

Codes with a payment limit
918
787 J codes, 85 Q codes, 32 CPT vaccine and immune globulin numbers
Effective
Effective October 1, 2026 through December 31, 2026
Pricing data
2Q26 ASP
Payment allowance limits subject to the ASP methodology are based on 2Q26 ASP data.
Standard coinsurance
800 codes at 20%
84 reduced, 34 at 0%
NDCs in the ASP crosswalk
7,222
322 labelers
Not payable (no NDRA)
7

What the payment limit is

Since January 1, 2005, Medicare has based payment for most Part B drugs on 106% of the average sales price (ASP), which manufacturers report to CMS every quarter for each 11-digit NDC. CMS combines the NDCs assigned to a HCPCS code, weights them by volume and converts the result to the code's billing unit, so the limit in the file is per unit of the HCPCS dosage, not per vial or per dose. Payment allowance limits subject to the ASP methodology are based on 2Q26 ASP data. The limits apply to services from October 1, 2026 through December 31, 2026.

Patients normally owe 20% coinsurance, the figure on 800 codes in this file. 84 codes carry a lower percentage: these are drugs whose prices rose faster than inflation, for which the coinsurance is reduced under the inflation rebate program. 34 codes carry 0%: preventive vaccines, HIV pre-exposure prophylaxis drugs and a few other products that Part B covers without coinsurance. The vaccine, blood and clotting factor columns mark codes priced another way: influenza, pneumococcal and hepatitis B vaccines and blood products other than immune globulin are paid at 95% of average wholesale price (30 vaccine codes and 4 blood products carry an AWP limit here), and 37 clotting factor codes are flagged in the clotting factor column.

How the NDC crosswalk and billing units work

A claim line reports the HCPCS code and the number of billing units; the NDC goes on the line as supplementary detail. The billing unit is the dosage in the code's descriptor, for example 1 mg or 10 units. The crosswalk gives, for every NDC, the package size (the amount in one item), the package quantity (items in the NDC) and the billable units per package, which CMS defines as the amount in the package divided by the code's dosage: a package containing 100 mcg of a drug whose code is defined per 5 mcg holds 20 billable units. Multiply the units actually administered by the payment limit to get the allowed amount; when part of a single-dose container is discarded, the discarded units are reported on a separate line with modifier JW, and modifier JZ states that nothing was discarded.

Unit conversions are where drug lines go wrong most often: a code defined per 10 mg billed as if it were per 1 mg pays a tenth of the right amount, or trips the MUE unit limit. The crosswalk is the authority for which code an NDC belongs to; an NDC that is missing from it is not in the ASP calculation for that quarter, which is one reason payers return remark codes for NDC and code mismatches.

The companion files

Each release ships the payment limit file with several crosswalks and lists. Row, code and NDC counts are from the October 2026 files as downloaded from CMS.

Files released with the October 2026 ASP payment limits
FileWhat it is forRowsCodesNDCs
ASP NDC-HCPCS crosswalkMaps each NDC in the ASP calculation to its HCPCS code, with package size, quantity and billable units per package.7,4038777,222
OPPS NDC-HCPCS crosswalkNDCs assigned to HCPCS codes for drugs priced under OPPS, including radiopharmaceuticals (A9 codes) and C-code pass-through drugs.28478284
AWP NDC-HCPCS crosswalkProducts priced on average wholesale price: vaccines (CPT numbers) and blood products.17333116
PrEP NDC-HCPCS crosswalkHIV pre-exposure prophylaxis drugs covered under Part B.38538
Seasonal vaccine price file and crosswalkInfluenza and COVID-19 vaccines for the August-to-July season.181518
Drugs not payable under Part BCodes whose manufacturer has no Medicaid national drug rebate agreement.77—

The seasonal vaccine files run on their own August-to-July calendar; the 2026-2027 limits, products and NDCs are on the flu and COVID-19 vaccine payment page. Hospital outpatient departments are paid for separately payable drugs (OPPS status indicator K) and pass-through drugs (status G) at amounts based on these limits, while packaged drugs (status N) are paid within the procedure's APC.

Drugs not payable under Part B this quarter

Section 1927(a)(1) of the Social Security Act makes Part B payment for a manufacturer's covered outpatient drugs depend on a Medicaid national drug rebate agreement. CMS lists the codes affected each quarter; claims for them deny for the quarter the listing covers.

HCPCS codes on the October 2026 not-payable list (no Medicaid national drug rebate agreement)
CodeHCPCS descriptorManufacturer
J0209Injection, sodium thiosulfate (hope), 100 mgHope Pharmaceuticals
J0211Injection, sodium nitrite 3 mg and sodium thiosulfate 125 mg (nithiodote)Hope Pharmaceuticals
J7330Autologous cultured chondrocytes, implantVericel Corporation
J7353Anacaulase-bcdb, 8.8% gel, 1 gramVericel Corporation
J8670Rolapitant, oral, 1 mgTerSera Therapeutics LLC
J9202Goserelin acetate implant, per 3.6 mgTerSera Therapeutics LLC
J9600Injection, porfimer sodium, 75 mgPinnacle Biologics, Inc.

Most searched drug codes in this file

Monthly US Google searches for the bare code (Google Ads, October 2026). Each code links to its reference page with the NDC billing units, MUE values and quarter-over-quarter change; the full table is on the HCPCS hub.

Ten most searched HCPCS drug codes with their October 2026 payment limits
CodeHCPCS short descriptorBilling unitLimit per unitSearches / month
J1939Inj, bumetanide, 0.5 mg0.5 MG$0.4932,400
J0585Injection,onabotulinumtoxina1 UNIT$6.5141,900
J0897Denosumab injection1 MG$29.8561,900
J3301Triamcinolone acet inj nos10 MG$0.7871,900
J1100Dexamethasone sodium phos1 MG$0.0991,600
J9271Inj pembrolizumab1 MG$62.2531,600
J1756Iron sucrose injection1 MG$0.2241,300
J1885Ketorolac tromethamine inj15 MG$0.5691,300
J1010Inj, methylpred acetate 1 mg1 MG$0.1231,000
J1745Infliximab not biosimil 10mg10 MG$29.8561,000

The most searched drug codes table on the HCPCS hub ranks every ASP-priced code the same way.

When the file changes

The payment limit file is replaced every quarter (January, April, July and October), using manufacturer sales data from two quarters earlier, and CMS re-posts a quarter's file when it corrects a limit. Because limits move every quarter, the allowed amount for the same NDC and units can differ between a claim for September 30 and one for October 1. The data-currency line at the top of this page shows the release loaded here and the next scheduled one, and the fee schedules hub lists the other Medicare payment files.

The October 2026 ASP movers report compares every payment limit in this file with the July 2026 file: the largest percentage and dollar changes each way, the codes new to the file and the drugs that lost Part B payment.

Where QuickIntell fits in drug billing

QuickCode supports qualified coder review of the units, NDC and edit questions this file answers before the claim leaves, and QuickRCM carries claim readiness and denial work for drug lines with human review. Contract management compares expected drug reimbursement with allowed and paid amounts.

See QuickCode for drug-line codingSee contract managementBook a meeting

Frequently asked questions

What is the ASP pricing file?

CMS's quarterly Medicare Part B drug payment limit file. The October 2026 file lists 918 HCPCS codes with the payment limit per billing unit, the coinsurance percentage and, for vaccines, blood products and clotting factors, the pricing basis.

How is the ASP payment limit calculated?

For most drugs the limit is 106% of the volume-weighted average sales price manufacturers report for the NDCs in the code, two quarters earlier. Influenza, pneumococcal and hepatitis B vaccines and blood products other than immune globulin are paid at 95% of average wholesale price, and a few codes follow other statutory rules.

How do I convert an NDC to billing units?

Divide the amount in the package by the HCPCS dosage in the code descriptor, or read the billable units per package from the NDC-HCPCS crosswalk, which covers 7,222 NDCs this quarter.

Why is a drug listed as not payable?

Part B pays for a manufacturer's covered outpatient drugs only if the manufacturer has a Medicaid national drug rebate agreement. The October 2026 not-payable list names 7 HCPCS codes.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

Operational reference compiled from the CMS ASP pricing files. Payment limits are Medicare national amounts per billing unit before coinsurance and claim-level adjustments; coverage is decided by the contractor. CPT numbers in the file are shown without descriptors. Not legal, coding or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.