CareCost Medicare allows
$1.361
per unit · ASP+6%, Q4 2026
Original Medicare: the patient owes $285.63 for an 800 mg infusion
20% of the $1,428.14 Medicare allows for the drug and its administration, after the Part B deductible. A Medigap plan can take that to $0.
Estimate for your patient ↓Enter the dose and weight, pick the plan, and add a Medigap plan if there is one.
Indication sets the usual dose · Example: 80 kg at 10 mg/kg, type over it
Leqembi's one-hour infusion bills 96365 alone; 96415 (each additional hour) does not apply. Include the office visit only when a significant, separately identifiable E/M service is performed and documented (modifier 25).
| Item | Qty | Payer allows | Patient owes |
|---|---|---|---|
| Leqembi (lecanemab-irmb) J0174 | 800 | $1,088.80 | $217.76 |
| Discarded amount (200 mg) J0174 | 200 | $272.20 | $54.44 |
| Infusion administration, initial hour 96365 | 1 | $67.14 | $13.43 |
| Total | $1,428.14 | $285.63 |
Medicare's 80% payment is reduced by the 2% sequester; the patient's 20% coinsurance is not affected.
The estimate above assumes the deductible is already met. Most patients are part-way through theirs for most of the year, and that changes what they owe today.
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Original Medicare · Leqembi · 800 mg
Patient owes · deductible met
Commercial estimates use the payer’s published rate and this patient’s actual benefits.
$1.361 per mg is Part B's ASP+6% rate for Q4 2026. Once the $283 Part B deductible is met, the patient owes the remaining 20% coinsurance on the administered drug, the discarded portion, and the infusion, with no annual out-of-pocket maximum to cap it. Full explanation: How Medicare Part B drug cost sharing works →
The starting regimen is dosed every 2 weeks for the first 18 months, 26 infusions a year, after which the prescriber may continue at that interval or move to an every-4-week maintenance schedule. Each infusion is billed the same way regardless of which interval is in effect.
Leqembi is dosed at 10 mg/kg, drawn from 500 mg and 200 mg vials using the fewest-vials rule. At 60 kg the ordered 600 mg draws one 500 mg vial and one 200 mg vial (700 mg), with the 100 mg not administered billed on its own JW line: the administered drug is 600 mg × $1.361 = $816.60 allowed, 20% of that is $163.32, and the 100 mg JW line is $136.10 allowed, 20% of that is $27.22.
| Weight | Dose | Vials drawn | Drug + JW allowed | Infusion allowed | Patient owes |
|---|---|---|---|---|---|
| 60 kg | 600 mg | 500 + 200 mg, 100 mg JW | $952.70 | $67.14 | $203.97 |
| 80 kg | 800 mg | 500 + 500 mg, 200 mg JW | $1,361.00 | $67.14 | $285.63 |
| 100 kg | 1,000 mg | 500 + 500 mg, none discarded (JZ) | $1,361.00 | $67.14 | $285.63 |
The 80 kg and 100 kg patients owe the same $285.63, because both draw the same two 500 mg vials. Medicare pays for the full 1,000 mg drawn either way: split between an administered line and a discarded JW line at 80 kg, or billed entirely as administered drug with the JZ modifier at 100 kg. The dose and vial math are built the same way at every visit: how the units and the JW/JZ line are built →
For the reference patient (80 kg, 10 mg/kg, 800 units, drug plus JW line plus the 96365 infusion code), Medicare allows $1,428.14, and the Part B coinsurance on that is $285.63. Plans A, B, C, D, F, G, M and N cover Part B coinsurance in full, so once the deductible is met those patients owe nothing per infusion. Plans K and L do not: Plan K owes $142.81 once the deductible is met and $397.51 before it is; Plan L owes $71.41 and $340.26. Leqembi is dosed every 2 weeks, so for most patients the deductible is satisfied by the first or second infusion of the year and the not-met figure applies only once. See what each Medigap plan (A–N) owes on this claim →
| Plan | Covers Part B deductible ($283) | Covers Part B coinsurance | Patient owes, deductible met | Patient owes, deductible not met |
|---|---|---|---|---|
| Plan K | No | 50% | $142.81 | $397.51 |
| Plan L | No | 75% | $71.41 | $340.26 |
Only the letters that leave this patient a balance are listed. The full A–N grid, the high-deductible variants, Plan N’s office-visit carve-out and the MACRA restriction on Plans C and F are at Medigap Plans A–N.
Commercial payers negotiate their own rate for J0174, not ASP+6%: our corpus holds published rates from 36 payer files. Aetna’s median is $1.20 per unit against Medicare’s $1.361, putting an 800 mg dose at $960.00 before benefits, plus the 200 mg discarded portion at the same rate if the payer pays for discarded drug: $240.00 more. Rates move by state as well as by payer, which is why the estimator above takes one. What the patient owes then depends on their specific benefits. Full explanation: How commercial drug reimbursement works →
Medicare pays the same ASP+6% rate for the Leqembi drug itself no matter where it's infused. The difference is what gets billed alongside it: an office infusion bills the physician fee schedule's 96365 administration code and, when documented, a separate office visit (99214), the codes used in the estimator above, while a hospital outpatient department bills its own facility fee under the hospital outpatient prospective payment system instead of those physician-fee-schedule codes. Our data doesn't carry a Leqembi-specific hospital-outpatient facility rate, so this estimator only prices the office/physician-fee-schedule path.
| Quarter | ASP+6% per mg |
|---|---|
| 2025 Q1 | $1.33 |
| 2025 Q2 | $1.33 |
| 2025 Q3 | $1.33 |
| 2025 Q4 | $1.32 |
| 2026 Q1 | $1.33 |
| 2026 Q2 | $1.34 |
| 2026 Q3 | $1.34 |
| 2026 Q4 (current) | $1.36 |
On a commercial plan, LEQEMBI Copay Assistance brings the drug copay to $0 per infusion, up to $10,000 a year; on the 800 mg example above, that is the difference between the $217.76 drug coinsurance the estimator shows and nothing. It covers the drug line only: it does not touch the JW discarded-drug line, the infusion administration, or an office visit, and it excludes Medicare, Medicaid, and other government program patients.
On Medicare it does not apply at all. Coverage runs through NCD 200.3's coverage-with-evidence-development pathway, so enrolling the patient in a CMS-approved registry (NACC's Alzheimer's Disease Patient Registry is the one this drug's own page names) is a coverage condition, not a billing option. A Medigap plan is the only route to reduce the coinsurance on Medicare. See every program for this patient, with current status →
For an 80 kg patient at the standard 10 mg/kg dose (800 mg), Medicare allows $1,428.14 for the drug, the discarded portion, and the infusion, and the patient's 20% coinsurance after the Part B deductible is $285.63.
$1.361 per mg for Q4 2026 (ASP+6%). An 80 kg patient at 10 mg/kg needs 800 mg, drawn as two 500 mg vials with 200 mg reported as discarded on a JW line, so Medicare's allowed amount is $1,088.80 for the administered drug plus $272.20 for the discarded portion.
No. LEQEMBI Copay Assistance brings the drug copay to $0 per infusion, up to $10,000 a year, but it covers the drug line only, not the discarded-drug line, the 96365 infusion administration, or an office visit. It also excludes Medicare, Medicaid, and other government program patients.
$1.361 per mg under Medicare's ASP+6% rate for Q4 2026. Aetna's commercial median across its published price files is lower, at $1.20 per mg.
No. LEQEMBI Copay Assistance excludes Medicare, Medicaid, and other government program patients. On Medicare, a Medigap plan is the only route to reduce the 20% coinsurance below what Original Medicare leaves.
Leqembi is dosed at 10 mg/kg, so heavier patients draw more vials. At 60 kg (600 mg) the coinsurance is $163.32 on the drug plus $27.22 on the 100 mg discarded on a JW line; at 80 kg (800 mg) it is $217.76 plus $54.44 on 200 mg discarded; at 100 kg (1,000 mg) two full vials are used with no discard, and the coinsurance is $272.20. Add $13.43 for the infusion at every weight.
Sources: CMS ASP pricing files (Q4 2026); Medicare physician fee schedule (96365, 99214, national non-facility); Medicare Part B deductible (2026); Medicare Rights Center 2026 Medigap plan benefits chart; 36 commercial payer published price files (Q2 2026); LEQEMBI Copay Assistance and LEQEMBI Companion Patient Assistance Program terms and status (public/programs-bundle.js, generated from the live programs corpus).
Reviewed September 20, 2026 by Erin Rose, CareCost Estimate founder. Methodology →