Headline numbers
- Codes in both files
- 848
- 886 Level II codes in October 2026
- Limits up
- 348
- Limits down
- 427
- Moved 20% or more
- 75
- 290 moved 5% or more
- Median change
- -0.01%
- New this quarter
- 37
- 10 left the file
How the October 2026 limits moved
Most limits move a little every quarter because each one is recomputed from a new quarter of manufacturers' sales. Of the 848 codes priced in both files, 485 changed by less than 5 percent and 73 did not change at all. The tails matter more for revenue: the 75 codes that moved 20 percent or more are where a fee schedule, a payer contract priced as a percentage of ASP or a charge master built on the July 2026 file is now furthest off.
25 largest percentage increases
J9304 leads the increases at +1057.2%, from $7.99 to $92.51 per 10 mg. Large percentage rises often sit on low per-unit limits, so read them with the dollar column before repricing.
| HCPCS | Descriptor | Billing unit | July 2026 | October 2026 | Change ($) | Change (%) |
|---|---|---|---|---|---|---|
| J9304 | Injection, pemetrexed (pemfexy), 10 mg | 10 MG | $7.99 | $92.51 | +$84.51 | +1057.2% |
| J3489 | Injection, zoledronic acid, 1 mg | 1 MG | $3.36 | $17.67 | +$14.31 | +425.8% |
| J2516 | Injection, pentamidine isethionate, 1 mg | 1 MG | $0.160 | $0.482 | +$0.322 | +201.3% |
| J1920 | Injection, labetalol hydrochloride, 5 mg | 5 MG | $0.218 | $0.588 | +$0.370 | +169.7% |
| Q9965 | Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml | 1 ML | $0.750 | $1.79 | +$1.04 | +138.3% |
| Q5120 | Injection, pegfilgrastim-bmez (ziextenzo), biosimilar, 0.5 mg | 0.5 MG | $132.10 | $302.25 | +$170.15 | +128.8% |
| J3379 | Injection, valproate sodium, 5 mg | 5 MG | $0.014 | $0.032 | +$0.018 | +128.6% |
| J1885 | Injection, ketorolac tromethamine, per 15 mg | 15 MG | $0.286 | $0.569 | +$0.283 | +99.0% |
| J1171 | Injection, hydromorphone, 0.1 mg | 0.1 MG | $0.136 | $0.224 | +$0.088 | +64.7% |
| J9263 | Injection, oxaliplatin, 0.5 mg | 0.5 MG | $0.055 | $0.087 | +$0.032 | +58.2% |
| J2151 | Injection, mannitol, 250 mg | 250 MG | $0.071 | $0.112 | +$0.041 | +57.8% |
| Q5112 | Injection, trastuzumab-dttb, biosimilar, (ontruzant), 10 mg | 10 MG | $20.99 | $32.79 | +$11.80 | +56.2% |
| J2175 | Injection, meperidine hydrochloride, per 100 mg | 100 MG | $6.34 | $9.65 | +$3.31 | +52.3% |
| J2596 | Injection, vasopressin (long grove), not therapeutically equivalent to j2598, 1 unit | 1 UNIT | $1.13 | $1.71 | +$0.578 | +51.0% |
| J2562 | Injection, plerixafor, 1 mg | 1 MG | $28.49 | $42.94 | +$14.45 | +50.7% |
| J0872 | Injection, daptomycin (xellia), unrefrigerated, not therapeutically equivalent to j0878 or j0873, 1 mg | 1 MG | $0.042 | $0.060 | +$0.018 | +42.9% |
| J1598 | Injection, glycopyrrolate (fresenius kabi), not therapeutically equivalent to j1596, 0.1 mg | 0.1 MG | $1.34 | $1.90 | +$0.562 | +41.9% |
| J0500 | Injection, dicyclomine hcl, up to 20 mg | 20 MG | $8.52 | $12.06 | +$3.54 | +41.6% |
| J2506 | Injection, pegfilgrastim, excludes biosimilar, 0.5 mg | 0.5 MG | $143.23 | $201.24 | +$58.01 | +40.5% |
| J0138 | Injection, acetaminophen 10 mg and ibuprofen 3 mg | 10 MG/3MG | $0.092 | $0.129 | +$0.037 | +40.2% |
| J7329 | Hyaluronan or derivative, trivisc, for intra-articular injection, 1 mg | 1 MG | $3.04 | $4.21 | +$1.17 | +38.6% |
| J0133 | Injection, acyclovir, 5 mg | 5 MG | $0.035 | $0.048 | +$0.013 | +37.1% |
| J0456 | Injection, azithromycin, 500 mg | 500 MG | $1.89 | $2.57 | +$0.682 | +36.1% |
| J1956 | Injection, levofloxacin, 250 mg | 250 MG | $1.91 | $2.57 | +$0.656 | +34.4% |
| J2690 | Injection, procainamide hcl, up to 1 gm | 1 GM | $295.36 | $394.87 | +$99.51 | +33.7% |
25 largest percentage decreases
J9305 fell the most, -82.3% to $1.23 per 10 mg. For a drug paid on the ASP method, a fall means the manufacturers' reported average sales price for the code fell; a practice still buying at the old price absorbs the difference.
| HCPCS | Descriptor | Billing unit | July 2026 | October 2026 | Change ($) | Change (%) |
|---|---|---|---|---|---|---|
| J9305 | Injection, pemetrexed, not otherwise specified, 10 mg | 10 MG | $6.95 | $1.23 | −$5.72 | -82.3% |
| J3105 | Injection, terbutaline sulfate, up to 1 mg | 1 MG | $2.82 | $1.00 | −$1.82 | -64.5% |
| Q5119 | Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg | 10 MG | $16.16 | $5.79 | −$10.37 | -64.2% |
| J8522 | Capecitabine, oral, 50 mg | 50 MG | $0.080 | $0.029 | −$0.051 | -63.8% |
| J0877 | Injection, daptomycin (hospira), not therapeutically equivalent to j0878, 1 mg | 1 MG | $0.057 | $0.022 | −$0.035 | -61.4% |
| J8700 | Temozolomide, oral, 5 mg | 5 MG | $0.425 | $0.208 | −$0.217 | -51.1% |
| J2778 | Injection, ranibizumab, 0.1 mg | 0.1 mg | $51.09 | $26.38 | −$24.71 | -48.4% |
| J9264 | Injection, paclitaxel protein-bound particles, 1 mg | 1 MG | $6.59 | $3.64 | −$2.95 | -44.7% |
| J7631 | Cromolyn sodium, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 10 milligrams | 10 MG | $0.691 | $0.385 | −$0.306 | -44.3% |
| J3000 | Injection, streptomycin, up to 1 gm | 1 GM | $26.88 | $16.41 | −$10.48 | -39.0% |
| J9033 | Injection, bendamustine hydrochloride, not otherwise specified, 1 mg | 1 MG | $2.96 | $1.85 | −$1.11 | -37.6% |
| J9261 | Injection, nelarabine, 50 mg | 50 MG | $65.41 | $40.87 | −$24.54 | -37.5% |
| J7510 | Prednisolone oral, per 5 mg | 5 MG | $0.777 | $0.498 | −$0.279 | -35.9% |
| J9293 | Injection, mitoxantrone hydrochloride, per 5 mg | 5 MG | $29.70 | $19.42 | −$10.28 | -34.6% |
| J1790 | Injection, droperidol, up to 5 mg | up to 5 MG | $8.12 | $5.35 | −$2.78 | -34.2% |
| Q5156 | Injection, tocilizumab-anoh (avtozma), biosimilar, 1 mg | 1 MG | $4.69 | $3.10 | −$1.59 | -34.0% |
| J2251 | Injection, midazolam in 0.9% sodium chloride, intravenous, not therapeutically equivalent to j2250, 1 mg | 1 MG | $0.117 | $0.078 | −$0.039 | -33.3% |
| J9025 | Injection, azacitidine, 1 mg | 1 MG | $0.401 | $0.269 | −$0.132 | -32.9% |
| J2599 | Injection, vasopressin (american regent), not therapeutically equivalent to j2598, 1 unit | 1 UNIT | $0.834 | $0.574 | −$0.260 | -31.2% |
| J1560 | Injection, gamma globulin, intramuscular, over 10 cc | 10 CC | $162.52 | $118.15 | −$44.37 | -27.3% |
| J7605 | Arformoterol, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 15 micrograms | 15 mcg | $0.742 | $0.542 | −$0.200 | -26.9% |
| J3360 | Injection, diazepam, up to 5 mg | 5 MG | $6.85 | $5.07 | −$1.79 | -26.0% |
| J1190 | Injection, dexrazoxane hydrochloride, per 250 mg | 250 MG | $41.44 | $30.83 | −$10.61 | -25.6% |
| J2246 | Injection, micafungin in sodium (baxter), not therapeutically equivalent to j2248, 1 mg | 1 MG | $0.448 | $0.334 | −$0.114 | -25.4% |
| J9351 | Injection, topotecan, 0.1 mg | 0.1 MG | $2.76 | $2.07 | −$0.692 | -25.1% |
Largest dollar changes per billing unit
Dollar moves rank the high-cost therapies: Q2053 rose +$22,248.82 per up to 200 million autologous anti-cd19 car positive viable t cells (+4.4%). For codes billed per therapeutic dose or per treatment, one unit is the whole dose, so these rows carry the largest claim-level effect.
| HCPCS | Descriptor | Billing unit | July 2026 | October 2026 | Change ($) | Change (%) |
|---|---|---|---|---|---|---|
| Q2053 | Brexucabtagene autoleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose | UP TO 200 MILLION AUTOLOGOUS ANTI-CD19 CAR POSITIVE VIABLE T CELLS | $510,103.92 | $532,352.74 | +$22,248.82 | +4.4% |
| Q2041 | Axicabtagene ciloleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose | UP TO 200 MILLION CAR T CELLS | $562,500.89 | $577,943.26 | +$15,442.37 | +2.8% |
| Q2042 | Tisagenlecleucel, up to 600 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose | up to 600 million CAR-positive viable T cells | $611,693.17 | $626,315.83 | +$14,622.66 | +2.4% |
| Q2054 | Lisocabtagene maraleucel, up to 110 million autologous anti-cd19 car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose | Up to 110 million CAR-positive viable T cells, per therapeutic dose | $579,570.61 | $589,846.77 | +$10,276.16 | +1.8% |
| Q2055 | Idecabtagene vicleucel, up to 510 million autologous b-cell maturation antigen (bcma) directed car-positive t cells, including leukapheresis and dose preparation procedures, per therapeutic dose | UP TO 510 MILLION AUTOLOGOUS ANTI-BCMA CAR-POSITIVE VIABLE T CELLS | $567,977.78 | $575,850.47 | +$7,872.69 | +1.4% |
| Q2056 | Ciltacabtagene autoleucel, up to 100 million autologous b-cell maturation antigen (bcma) directed car-positive t cells, including leukapheresis and dose preparation procedures, per therapeutic dose | up to 100 million autologous b-cell maturation antigen (bcma) directed car-positive t cells | $587,977.76 | $594,112.26 | +$6,134.50 | +1.0% |
| J9029 | Intravesical instillation, nadofaragene firadenovec-vncg, per therapeutic dose | PER THERAPEUTIC DOSE | $64,331.61 | $65,200.56 | +$868.95 | +1.4% |
| Q0224 | Injection, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known sars-cov-2 exposure, and who either have moderate-to-severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments, and are unlikely to mount an adequate immune response to covid-19 vaccination, 4500 mg | 4500 MG | $7,239.00 | $7,615.20 | +$376.20 | +5.2% |
| J9226 | Histrelin implant (supprelin la), 50 mg | 50 MG | $37,491.97 | $37,837.55 | +$345.57 | +0.9% |
| J1162 | Injection, digoxin immune fab (ovine), per vial | PER VIAL | $5,383.32 | $5,711.37 | +$328.05 | +6.1% |
| J9266 | Injection, pegaspargase, per single dose vial | 1 EA | $29,663.97 | $29,845.27 | +$181.30 | +0.6% |
| Q5120 | Injection, pegfilgrastim-bmez (ziextenzo), biosimilar, 0.5 mg | 0.5 MG | $132.10 | $302.25 | +$170.15 | +128.8% |
| J0840 | Injection, crotalidae polyvalent immune fab (ovine), up to 1 gram | UP TO 1 GM | $1,906.91 | $2,044.38 | +$137.48 | +7.2% |
| J2690 | Injection, procainamide hcl, up to 1 gm | 1 GM | $295.36 | $394.87 | +$99.51 | +33.7% |
| J9304 | Injection, pemetrexed (pemfexy), 10 mg | 10 MG | $7.99 | $92.51 | +$84.51 | +1057.2% |
| J0600 | Injection, edetate calcium disodium, up to 1000 mg | 1000 MG | $6,189.49 | $6,273.87 | +$84.38 | +1.4% |
| J2507 | Injection, pegloticase, 1 mg | 1 MG | $3,929.34 | $4,000.63 | +$71.29 | +1.8% |
| J9183 | Gemcitabine intravesical system, 225 mg | 225 MG | $72,984.24 | $73,054.05 | +$69.81 | +0.1% |
| J7327 | Hyaluronan or derivative, monovisc, for intra-articular injection, per dose | PER DOSE | $565.28 | $626.14 | +$60.87 | +10.8% |
| J2506 | Injection, pegfilgrastim, excludes biosimilar, 0.5 mg | 0.5 MG | $143.23 | $201.24 | +$58.01 | +40.5% |
| J2805 | Injection, sincalide, 5 micrograms | 5 MCG | $110.46 | $145.64 | +$35.18 | +31.8% |
| J9217 | Leuprolide acetate (for depot suspension), 7.5 mg | 7.5 MG | $160.34 | $188.85 | +$28.51 | +17.8% |
| Q5127 | Injection, pegfilgrastim-fpgk (stimufend), biosimilar, 0.5 mg | 0.5 MG | $143.67 | $163.95 | +$20.28 | +14.1% |
| J7324 | Hyaluronan or derivative, orthovisc, for intra-articular injection, per dose | PER DOSE | $100.33 | $116.79 | +$16.46 | +16.4% |
| J2562 | Injection, plerixafor, 1 mg | 1 MG | $28.49 | $42.94 | +$14.45 | +50.7% |
The largest per-unit dollar decreases. Each one lowers what Medicare allows per unit from the first claim with a date of service on or after the quarter's effective date.
| HCPCS | Descriptor | Billing unit | July 2026 | October 2026 | Change ($) | Change (%) |
|---|---|---|---|---|---|---|
| J3402 | Injection, remestemcel-l-rknd, per therapeutic dose | Per Therapeutic Dose | $203,659.76 | $202,159.94 | −$1,499.83 | -0.7% |
| Q2043 | Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion | Per infusion (minimum 50 million cells) | $55,932.43 | $55,663.13 | −$269.30 | -0.5% |
| J0801 | Injection, corticotropin (acthar gel), up to 40 units | 40 UNITS | $4,133.45 | $3,884.27 | −$249.18 | -6.0% |
| J9268 | Injection, pentostatin, 10 mg | 10 MG | $2,697.99 | $2,612.89 | −$85.09 | -3.1% |
| J1560 | Injection, gamma globulin, intramuscular, over 10 cc | 10 CC | $162.52 | $118.15 | −$44.37 | -27.3% |
| J9050 | Injection, carmustine, 100 mg | 100 MG | $240.01 | $195.73 | −$44.28 | -18.4% |
| J1950 | Injection, leuprolide acetate (for depot suspension), per 3.75 mg | 3.75 MG | $1,841.26 | $1,799.05 | −$42.21 | -2.3% |
| J7504 | Lymphocyte immune globulin, antithymocyte globulin, equine, parenteral, 250 mg | 250 MG | $5,548.96 | $5,509.07 | −$39.89 | -0.7% |
| Q5147 | Injection, aflibercept-ayyh (pavblu), biosimilar, 1 mg | 1 MG | $803.26 | $763.38 | −$39.88 | -5.0% |
| J0202 | Injection, alemtuzumab, 1 mg | 1 MG | $2,544.94 | $2,506.20 | −$38.74 | -1.5% |
| J9185 | Injection, fludarabine phosphate, 50 mg | 50 MG | $206.30 | $177.92 | −$28.38 | -13.8% |
| J0802 | Injection, corticotropin (ani), up to 40 units | up to 40 Units | $3,674.68 | $3,646.46 | −$28.22 | -0.8% |
| J7525 | Tacrolimus, parenteral, 5 mg | 5 MG | $268.18 | $242.07 | −$26.10 | -9.7% |
| J2778 | Injection, ranibizumab, 0.1 mg | 0.1 mg | $51.09 | $26.38 | −$24.71 | -48.4% |
| J9261 | Injection, nelarabine, 50 mg | 50 MG | $65.41 | $40.87 | −$24.54 | -37.5% |
| J1454 | Injection, fosnetupitant 235 mg and palonosetron 0.25 mg | 0.25 MG | $503.85 | $479.90 | −$23.95 | -4.8% |
| J0178 | Injection, aflibercept, 1 mg | 1 MG | $743.61 | $722.25 | −$21.35 | -2.9% |
| Q5111 | Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg | 0.5 MG | $149.13 | $128.97 | −$20.17 | -13.5% |
| Q2050 | Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg | 10 MG | $116.61 | $97.82 | −$18.78 | -16.1% |
| J8655 | Netupitant 300 mg and palonosetron 0.5 mg, oral | 0.5 MG | $474.04 | $455.76 | −$18.28 | -3.9% |
| J9357 | Injection, valrubicin, intravesical, 200 mg | 200 MG | $1,247.05 | $1,230.66 | −$16.38 | -1.3% |
| J9245 | Injection, melphalan hydrochloride, not otherwise specified, 50 mg | 50 MG | $104.90 | $90.03 | −$14.87 | -14.2% |
| J1205 | Injection, chlorothiazide sodium, per 500 mg | 500 MG | $77.77 | $63.40 | −$14.37 | -18.5% |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 1 MG | $148.94 | $135.27 | −$13.68 | -9.2% |
| J1430 | Injection, ethanolamine oleate, 100 mg | 100 MG | $547.27 | $533.77 | −$13.50 | -2.5% |
37 codes priced for the first time
These codes have a payment limit in October 2026 and none in July 2026. 16 of the 37 were created by the October 2026 HCPCS update: 3 replace a temporary C code (J0014 for C9046, J0644 for C9310 and J3268 for C9462); 9 replace a discontinued code for the same drug at a different billing unit; and 4 have no discontinued counterpart. The October 2026 HCPCS update report lists each replacement. 13 were added by earlier HCPCS updates (10 in July 2026, 2 in April 2026 and 1 in January 2026) and are priced for the first time. The other 8 are older codes (added between 1998 and 2025): J0716 and J0841 came off the not-payable list this quarter, and 6 were not in the July 2026 file.
| HCPCS | Descriptor | Billing unit | October 2026 limit |
|---|---|---|---|
| J0014 | Cocaine hydrochloride nasal solution (goprelto), 1 mg | 1 MG | $1.83 |
| J0528 | Injection, fosfomycin disodium, 20 mg | 20 MG | $0.633 |
| J0643 | Injection, leucovorin calcium, not otherwise specified, 1 mg | 1 MG | $0.054 |
| J0644 | Injection, leucovorin calcium (avyxa), 1 mg | 1 MG | $2.63 |
| J0716 | Injection, centruroides immune f(ab)2, up to 120 milligrams | UP TO 120MG | $5,449.65 |
| J0841 | Injection, crotalidae immune f(ab')2 (equine), 120 mg | 120 MG | $1,084.91 |
| J0871 | Injection, daptomycin (endo), not therapeutically equivalent to j0878, 1 mg | 1 MG | $0.541 |
| J1289 | Injection, narsoplimab-wuug, 1 mg | 1 MG | $105.44 |
| J1577 | Injection, immune globulin (qivigy), 100 mg | 100 MG | $29.28 |
| J1737 | Injection, meloxicam (azurity), 1 mg | 1 MG | $1.06 |
| J1957 | Injection, levetiracetam, 5 mg | 5 MG | $0.013 |
| J1958 | Injection, levetiracetam in sodium chloride, 5 mg | 5 MG | $0.033 |
| J2361 | Injection, depemokimab-ulaa, 1 mg | 1 MG | $275.39 |
| J2374 | Apraclonidine hydrochloride ophthalmic, 1% solution, 0.1 ml | 0.1 ML | $28.80 |
| J2789 | Riboflavin 5'-phosphate, ophthalmic solution (epioxahd/epioxa), up to 2 ml | UP TO 2 ML | $41,359.62 |
| J3268 | Injection, delafloxacin, 1 mg | 1 MG | $0.478 |
| J3404 | Injection, zopapogene imadenovec-drba suspension, per therapeutic dose | Per Therapeutic Dose | $119,675.51 |
| J3405 | Injection, onasemnogene abeparvovec-brve, per treatment | Per treatment | $2,729,937.92 |
| J7524 | Mycophenolate mofetil, oral, 5 mg | 5 MG | $0.002 |
| J7526 | Injection, mycophenolate mofetil, 5 mg | 5 MG | $0.200 |
| J7529 | Mycophenolate mofetil, for suspension, oral, 5 mg | 5 MG | $0.034 |
| J7530 | Mycophenolate mofetil (myhibbin), oral suspension, 5 mg | 5 MG | $0.115 |
| J8541 | Dexamethasone (hemady), oral, 0.25 mg | 0.25 MG | $0.375 |
| J9186 | Injection, etoposide (avyxa), 1 mg | 1 MG | $4.24 |
| J9187 | Injection, etoposide, 1 mg | 1 MG | $0.094 |
| J9191 | Injection, fluorouracil (avyxa), 10 mg | 10 MG | $14.84 |
| J9192 | Injection, fluorouracil, 10 mg | 10 MG | $0.039 |
| J9275 | Injection, cosibelimab-ipdl, 2 mg | 2 MG | $21.99 |
| J9318 | Injection, romidepsin, non-lyophilized, 0.1 mg | 0.1 MG | $32.86 |
| J9361 | Injection, efbemalenograstim alfa-vuxw, 0.5 mg | 0.5 MG | $121.43 |
| J9362 | Injection, trabectedin, 0.01 mg | 0.01 MG | $41.84 |
| Q0166 | Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen | 1 MG | $0.774 |
| Q2058 | Obecabtagene autoleucel, 10 up to 400 million cd19 car-positive viable t cells, including leukapheresis and dose preparation procedures, per infusion | Per Therapeutic Dose | $293,725.70 |
| Q5161 | Injection, denosumab-kyqq (aukelso/bosaya), biosimilar, 1 mg | 1 MG | $27.51 |
| Q5167 | Injection, denosumab-qbde (enoby/xtrenbo), biosimilar, 1 mg | 1 MG | $7.68 |
| Q5168 | Injection, ranibizumab-leyk (nufymco), biosimilar, 0.1 mg | 0.1 MG | $26.38 |
| Q5169 | Injection, pegfilgrastim-unne (armlupeg), biosimilar, 0.5 mg | 0.5 MG | $519.48 |
10 codes no longer in the file
These codes had a July 2026 limit and are absent from the October 2026 file. 9 of the 10 were discontinued in the October 2026 HCPCS update, each replaced by a code for the same drug at a smaller billing unit, so the units on the claim change with the code. J9394 is still an active HCPCS code with no payment limit in October 2026.
| HCPCS | Descriptor | Billing unit | July 2026 limit |
|---|---|---|---|
| J0640 | Injection, leucovorin calcium, per 50 mg | 50 MG | $2.93 |
| J1953 | Injection, levetiracetam, 10 mg | 10 MG | $0.032 |
| J7514 | Mycophenolate mofetil (myhibbin), oral suspension, 100 mg | 100 MG | $2.30 |
| J7517 | Mycophenolate mofetil, oral, 250 mg | 250 MG | $0.131 |
| J7519 | Injection, mycophenolate mofetil, 10 mg | 10 MG | $0.399 |
| J7528 | Mycophenolate mofetil, for suspension, oral, 100 mg | 100 MG | $0.164 |
| J9181 | Injection, etoposide, 10 mg | 10 MG | $1.02 |
| J9190 | Injection, fluorouracil, 500 mg | 500 MG | $2.02 |
| J9352 | Injection, trabectedin, 0.1 mg | 0.1 MG | $410.48 |
| J9394 | Injection, fulvestrant (fresenius kabi) not therapeutically equivalent to j9395, 25 mg | 25 MG | $27.11 |
Drugs not payable under Part B in October 2026
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 (NDRA). CMS publishes the codes it knows to be affected alongside the payment limits; a claim line for one of them is not paid until the manufacturer has an agreement in effect. The October 2026 list names 7 codes, 2 of them new since July 2026, and 3 codes from the July 2026 list are no longer on it.
| HCPCS | Descriptor | Manufacturer | On the July 2026 list |
|---|---|---|---|
| J0209 | Injection, sodium thiosulfate (hope), 100 mg | Hope Pharmaceuticals | no, new |
| J0211 | Injection, sodium nitrite 3 mg and sodium thiosulfate 125 mg (nithiodote) | Hope Pharmaceuticals | no, new |
| J7330 | Autologous cultured chondrocytes, implant | Vericel Corporation | yes |
| J7353 | Anacaulase-bcdb, 8.8% gel, 1 gram | Vericel Corporation | yes |
| J8670 | Rolapitant, oral, 1 mg | TerSera Therapeutics LLC | yes |
| J9202 | Goserelin acetate implant, per 3.6 mg | TerSera Therapeutics LLC | yes |
| J9600 | Injection, porfimer sodium, 75 mg | Pinnacle Biologics, Inc. | yes |
Removed from the list since July 2026: A9521 (Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries); J0716 (Injection, centruroides immune f(ab)2, up to 120 milligrams); J0841 (Injection, crotalidae immune f(ab')2 (equine), 120 mg).
What to do with this list
Load the October 2026 limits into the billing system before the first claim with a date of service on or after 2026-10-01; Medicare pays the lesser of the billed charge and the limit, so a charge set from the July 2026 file can leave money on the table where the limit rose and generate write-offs where it fell. Contracts that pay a percentage of ASP depend on the same file, so check which quarter each contract references.
For a discontinued code, switch to its replacement and convert units: 9 of this quarter's replacements bill a smaller unit (for example J9192 at 10 mg in place of J9190 at 500 mg), so the units on the claim rise even when the dose does not. Check each code's medically unlikely edit on the MUE lookup after a unit change, and find every code for a drug, generic or brand, in the J code lookup by generic or brand name.
For codes on the not-payable list, hold claims or switch products with the prescriber; an NDRA denial is not a documentation problem that an appeal can fix. Every code above links to its HCPCS drug code page with the NDC crosswalk, MUE, NCCI and coverage articles.
Method
Both quarters are read from the CMS section 508 CSV versions of the Medicare Part B payment limit file; only HCPCS Level II codes are compared, so vaccine and other CPT-coded rows are excluded. The change is the October 2026 limit minus the July 2026 limit per billing unit, and the percentage is over the July 2026 limit. Descriptors come from the HCPCS Level II alpha-numeric file. The computation is described on the reference methodology page.
Part of the ASP quarterly movers series, rebuilt from each CMS release. Next edition: January 2027 edition after the January 1, 2027 ASP release. Earlier and later editions are listed on the research index.
Download the full table
The CSV holds every HCPCS Level II code in the October 2026 and July 2026 payment limit files with both limits, the change and its NDRA status: 896 rows, one header row and the columns hcpcs, descriptor, billing unit, limit 2026-07, limit 2026-10, change usd, change pct, status, not payable ndra. Its first line is a comment that names each CMS source file with its SHA-256, the data date and the attribution line to keep when you reuse the table.
Table SHA-256 (the rows after the comment line): f8f0442d4225a4c983adc58470b7dd67b5b7c3d53884b5839d5f6293bfea7c2a. Data as of 2026-10-01.
Where QuickIntell fits when drug prices move
A price change reaches the claim through units, NDCs and edits. QuickCode supports qualified coder review of the units, NDC and edit questions before the claim leaves, and QuickRCM carries claim readiness and denial work for drug lines with human review.
Frequently asked questions
How is a Medicare Part B ASP payment limit set?
For most separately payable Part B drugs the payment limit is 106 percent of the manufacturer-reported average sales price per HCPCS billing unit, under section 1847A of the Social Security Act. CMS publishes the limits every quarter; the October 2026 file states that its ASP-based limits use second-quarter 2026 sales data, so each quarter's limits trail manufacturers' sales by about two quarters.
How many drug codes changed price in October 2026?
Of the 886 HCPCS Level II codes in the October 2026 file, 848 also had a July 2026 limit. 348 rose, 427 fell and 73 were unchanged; 290 moved by 5 percent or more and 75 by 20 percent or more. The median change was -0.01%.
Why do some limits change by more than 100 percent?
The limit is a per-unit figure computed from manufacturers' reported sales, so a change in the products sold under a code, a new manufacturer or a first full quarter of sales data can move it sharply, especially for codes with small billing units. CMS does not publish the reason for an individual change; check the code's NDC crosswalk rows and the manufacturer's labeling before repricing.
Does a code missing from the ASP file mean Medicare does not cover the drug?
No. CMS notes in the file that the absence or presence of a HCPCS code and its payment limit does not indicate whether Medicare covers a drug; the local contractor decides. Codes on the separate list of drugs not payable under Part B (7 in October 2026) are different: they cannot be paid while the manufacturer has no Medicaid drug rebate agreement.
When does the next ASP file take effect?
CMS replaces the payment limits every calendar quarter, on January 1, April 1, July 1 and October 1. The next file takes effect on January 1, 2027, and this report's January 2027 edition will compare it with October 2026.
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.
- Medicare Part B Drug Payment Limit File, October 2026Version October 2026 · effective 2026-10-01 · file section 508 version of October 2026 Medicare Part B Payment Limit File 091626.csvSHA-256 508fba376a29e099…
- Medicare Part B Drug Payment Limit File, July 2026Version July 2026 · effective 2026-07-01 · file section 508 version of July 2026 Medicare Part B Payment Limit File updated 082026.csvSHA-256 13bb5b644b92b574…
- Drugs Not Payable Under Part B (no Medicaid drug rebate agreement), October 2026Version October 2026 · effective 2026-10-01 · file section 508 version of October 2026 Drugs Not Payable Under Part B 091426.csvSHA-256 aa6cd1c3652719fb…
- HCPCS Level II alpha-numeric file, October 2026Version October 2026 · effective 2026-10-01 · file HCPC2026_OCT_ANWEB_09232026.txtSHA-256 c25240c63108756d…
Disclaimer
Payment limits are Medicare national amounts per billing unit; Medicare Advantage and commercial payers set their own rates. Operational reference, not legal, clinical 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.