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HCPCS Part B drug codes: payment, units and edits in one place

772 ASP-priced HCPCS Level II codes, each joined across six CMS files: the October 2026 payment limit with its quarter-over-quarter change, the NDC crosswalk with billing units per package, MUE values for practitioner, facility and DME settings, NCCI PTP and add-on exposure, OPPS status indicator and the Medicare coverage articles that list the code.

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: ASP payment limits October 2026 (effective October 1, 2026); MUE and NCCI 2026 Q4 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly updates).

Browse by code range

Drugs administered other than oral method, chemotherapy drugs (J codes)
787 codes
Temporary codes (Q codes)
85 codes
Medical and surgical supplies, administrative (A codes)
10 codes
Other ASP-priced HCPCS codes
4 codes

Highest payment limits per billing unit

Per-unit limits are not per-dose costs: a 1 mg unit of a biologic can multiply into thousands of dollars per administration, which is why unit errors on these codes are the most expensive drug-line denials.

Ten highest ASP payment limits, October 2026
CodeDescriptorLimit / unitPractitioner MUE
Q2057Afamitresgene autoleucel, including leukapheresis and dose preparation$813,967.3751
Q2058Obecabtagene autoleucel, 10 up to 400 million cd19 car-positive viable t cells,$293,725.7021
J9029Intravesical instillation, nadofaragene firadenovec-vncg, per therapeutic dose$65,200.5631
Q2043Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with$55,663.1311
J9226Histrelin implant (supprelin la), 50 mg$37,837.5481
J9266Injection, pegaspargase, per single dose vial$29,845.2652
Q0224Injection, pemivibart, for the pre-exposure prophylaxis only, for certain$7,615.201
J0600Injection, edetate calcium disodium, up to 1000 mg$6,273.8653
J1162Injection, digoxin immune fab (ovine), per vial$5,711.3731
J7504Lymphocyte immune globulin, antithymocyte globulin, equine, parenteral, 250 mg$5,509.07215

Drug codes with the most NCCI column-2 pairs

Across 2,637,645 practitioner PTP rows in v323r0, these drug codes are most often the bundled component of another service; billing them with the column-1 code on the same date triggers CARC 97 unless a modifier is allowed and supported.

Drug codes appearing most often as NCCI column-2 (bundled) codes
CodeDescriptorColumn-2 pairs
J0670Injection, mepivacaine hydrochloride, per 10 ml1548
J1644Injection, heparin sodium, per 1000 units299
J1642Injection, heparin sodium, (heparin lock flush), per 10 units274
J2002Injection, lidocaine hcl in 5% dextrose, 1 mg7
Q9965Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml7
Q9966Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml6
Q9967Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml5
Q9958High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml4
Q9961High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml2
J1460Injection, gamma globulin, intramuscular, 1 cc1

Frequently asked questions

What is an ASP payment limit?

The Medicare Part B payment limit for most separately payable drugs equals the manufacturer-reported average sales price plus 6%, published quarterly by CMS. Contractors pay the lesser of the limit or the billed charge, less 20% beneficiary coinsurance.

How do I convert an NDC package into HCPCS billing units?

Divide the quantity administered by the HCPCS descriptor unit (for example 1 mg) to get the units billed, and report the NDC with its quantity in the claim's drug segment. The ASP NDC-HCPCS crosswalk lists billing units per package for each NDC.

What happens when units exceed the MUE?

The claim line (MAI 1) or the whole date of service (MAI 2 and 3) denies with CARC 151 and remark N362. MAI 3 denials can be appealed with documentation of medical necessity; MAI 2 policy limits rarely are.

How often does this data change?

CMS updates ASP limits, the NDC crosswalk, MUE tables and NCCI edits every quarter (January, April, July, October) and OPPS Addendum B quarterly; these pages are rebuilt from each release.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-01. Verify against the primary file before billing or contracting decisions.

Disclaimer

Operational reference compiled from CMS publications. Payment limits are Medicare national amounts; other payers differ. CPT codes appear as numbers only. Not legal, clinical or billing advice.