CareCost Medicare allows
$381.627
per unit · ASP+6%, Q4 2026
Original Medicare: the patient owes $15,291.73 for a 1,600 mg infusion
20% of the $76,458.67 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. H05.24 is a category code; the claim itself needs the laterality digit, H05.241–H05.249 by eye.
Indication sets the usual dose · Example: 80 kg at 20 mg/kg, type over it
A Tepezza infusion run at the label minimum bills 96413 alone; 96415 (each additional hour) applies only when the drip actually runs past 90 minutes, and a payer that places teprotumumab-trbw in the therapeutic-infusion family instead wants 96365 (96366 past 90 minutes). 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 |
|---|---|---|---|
| Tepezza (teprotumumab-trbw) J3241 | 160 | $61,060.32 | $12,212.06 |
| Discarded amount (400 mg) J3241 | 40 | $15,265.08 | $3,053.02 |
| Infusion administration, initial hour 96413 | 1 | $133.27 | $26.65 |
| Total | $76,458.67 | $15,291.73 |
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 · Tepezza · 1,600 mg
Patient owes · deductible met
Commercial estimates use the payer’s published rate and this patient’s actual benefits.
$381.627 per unit (10 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 and the infusion, with no annual out-of-pocket maximum to cap it. A draw that pulls more from a vial than the dose needs is billed on its own discarded-drug line at the same rate. Full explanation: How Medicare Part B drug cost sharing works →
Tepezza is billed as a single course, not a recurring maintenance schedule: 10 mg/kg for the first infusion, then 20 mg/kg every 3 weeks for seven more, eight infusions in about 21 weeks. For an 80 kg adult the first infusion is 800 mg — 80 units of J3241 administered at $30,530.16 plus 20 units (200 mg) discarded on a JW line at $7,632.54, with no allowed total typed here since the infusion administration code varies by claim. The seven 20 mg/kg infusions that follow price the same as the worked example above, $76,458.67 allowed each, $535,210.69 across those seven before the first infusion is added. BCBS Kansas states Tepezza “will be covered for one course of therapy per lifetime,” so a second course is a medical-policy exception rather than a routine reauthorization.
The label sets no dose ceiling for Tepezza, so a maintenance claim is always 20 mg/kg of body weight, and the only variable across patients is how many 500 mg vials that dose needs — it is the only vial size Tepezza comes in. A 70 kg patient needs 1,400 mg: three 500 mg vials draw 1,500 mg, so the administered line is 140 units = $53,427.78 and the remaining 100 mg (10 units) is billed on a separate JW line at $3,816.27. A 100 kg patient needs 2,000 mg: exactly four 500 mg vials, so the administered line is 200 units = $76,325.40 with nothing discarded — that claim carries modifier JZ instead of a JW line.
| Weight | Dose | Vials drawn | Administered line | Discarded |
|---|---|---|---|---|
| 70 kg | 1,400 mg (20 mg/kg) | Three 500 mg vials | 140 units · $53,427.78 | 10 units JW · $3,816.27 |
| 100 kg | 2,000 mg (20 mg/kg) | Four 500 mg vials, no waste | 200 units · $76,325.40 | JZ · none |
The J3241 MUE is 500 units a day, 5,000 mg, which is what a 250 kg patient at 20 mg/kg would need: a claim above that line needs its own review, but nothing in the label stops a dose from reaching it. The dose and vial math, including the JW/JZ line, are built the same way at every visit: how the units and the JW/JZ line are built →
For the reference patient (80 kg, 20 mg/kg, 160 units, drug plus the 96413 infusion code), Medicare allows $76,458.67, and the Part B coinsurance on that is $15,291.73. 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 $7,645.87 once the deductible is met and $7,900.57 before it is; Plan L owes $3,822.93 and $4,091.78. Most patients meet the $283 deductible by their first infusion of the year, so the not-met figure applies only once regardless of how often Tepezza is given afterward. 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% | $7,645.87 | $7,900.57 |
| Plan L | No | 75% | $3,822.93 | $4,091.78 |
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.
Payers other than Medicare negotiate their own rate for J3241, not ASP+6%: our corpus holds published rates from 37 of 37 payer files. Aetna’s median is $383.89 per unit against Medicare’s $381.627, putting the 160 administered units of the worked example at $61,422.40 before benefits, close to the $61,060.32 Medicare allows for the same 160 units. 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 →
No teprotumumab-trbw biosimilar exists, and no other drug carries a J-code in the same class: Tepezza has no priced alternative on this page. There is also no subcutaneous Tepezza product; every claim here is a buy-and-bill infusion billed as J3241. See how coverage requirements compare by payer →
Medicare pays the same ASP+6% rate for the Tepezza 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 96413 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 Tepezza-specific hospital-outpatient facility rate, so this estimator only prices the office/physician-fee-schedule path.
| Quarter | ASP+6% per unit (10 mg) |
|---|---|
| 2025 Q1 | $347.10 |
| 2025 Q2 | $352.56 |
| 2025 Q3 | $359.09 |
| 2025 Q4 | $359.19 |
| 2026 Q1 | $369.31 |
| 2026 Q2 | $367.91 |
| 2026 Q3 | $379.90 |
| 2026 Q4 (current) | $381.627 |
On a commercial plan, the TEPEZZA Co-pay Program, run through Amgen By Your Side, brings eligible patients to $0 for both the drug and the infusion administration, with an annual maximum listed only as “See program” — call 833-469-8331 for the current cap. It excludes Medicare, Medicaid, TRICARE, VA and other government coverage, and it is not available to a patient receiving any other foundation or manufacturer assistance for the same claim. For uninsured patients, the Amgen SafetyNet Foundation ships Tepezza free of charge; both programs were last checked April 8, 2026 and share the same phone line.
On Medicare, the copay program does not apply, but one foundation fund for this diagnosis is open today: The Assistance Fund’s Thyroid Eye Disease grant, with no stated maximum, status checked June 3, 2026. Good Days also lists a Thyroid Eye Disease fund, but it is on a waitlist as of July 31, 2026 and not accepting new applicants. A Medigap plan remains the only guaranteed route to reduce the coinsurance on Medicare. See every program for this patient, with current status →
For an 80 kg adult at the 20 mg/kg maintenance dose (1,600 mg), Medicare allows $76,458.67 for the drug and its administration, and the patient's 20% coinsurance after the Part B deductible is $15,291.73.
$381.627 per unit (10 mg) under Part B's ASP+6% rate for Q4 2026. An 80 kg adult at 20 mg/kg needs 1,600 mg, drawn from four 500 mg vials with 400 mg discarded on a JW line, so Medicare's allowed amount is $76,325.40 for the drug plus $133.27 for the 96413 infusion.
Yes. The TEPEZZA Co-pay Program, through Amgen By Your Side, brings eligible commercial patients to $0 for both the drug and the infusion administration. It excludes Medicare, Medicaid, TRICARE, VA, and other government program patients.
$381.627 per unit (10 mg) under Medicare's ASP+6% rate for Q4 2026. Aetna's commercial median across its published price files is close to that, at $383.89 per unit.
No. The TEPEZZA Co-pay Program for J3241 excludes Medicare, Medicaid, and other government program patients. On Medicare, The Assistance Fund's Thyroid Eye Disease grant is open with no stated maximum; Good Days also lists a Thyroid Eye Disease fund, but it is on a waitlist.
At the 20 mg/kg maintenance dose, a 70 kg patient needs 1,400 mg: 140 units from three 500 mg vials, with 10 units (100 mg) discarded on a separate JW line. A 100 kg patient needs 2,000 mg: exactly 200 units from four 500 mg vials, with nothing discarded. The course's first infusion is 10 mg/kg; for an 80 kg adult that is 800 mg, billed as 80 units plus 20 units on a JW line. The label sets no maximum dose.
Sources: CMS ASP pricing files (Q4 2026); Medicare physician fee schedule (96413, 99214, national non-facility); Medicare Part B deductible (2026); Medicare Rights Center 2026 Medigap plan benefits chart; 37 commercial payer published price files (Q2 2026); TEPEZZA Co-pay Program and Amgen SafetyNet Foundation terms and status (public/programs-bundle.js, generated from the live programs corpus).
Reviewed September 21, 2026 by Erin Rose, CareCost Estimate founder. Methodology →