Reviewed Sep 22, 2026 · maintained by Erin Rose · general reference, not legal advice
How to read this page
CMS publishes the Part B payment-limit file every quarter. A code that appears for the first time is a new HCPCS code — usually a drug that was billed as unclassified (J3490, J3590, C9399) until CMS assigned it a permanent J-code, or a biosimilar getting its Q5 code. A code that drops out is retired: the product was discontinued, folded into another code, or moved off the ASP methodology. On the effective date, claims with the old code start denying and claims with the new one start paying — and the NDC crosswalk moves with it.
The current quarter is expanded below; earlier quarters are collapsed. Codes link to their drug page when this site has one. Payment limits are CMS's published figure per billing unit — ASP + 6% for most drugs; for a biosimilar CMS adds 8% of the reference product's ASP instead, and the IRA inflation rebate lowers some. When a retired code has a successor, the Bill instead column names it and the unit multiplier — a code renumbered from per 500 mg to per 10 mg means the same dose is 50× the units, which is the billing-units trap of every renumbering quarter.
Q4 2026 — current quarter
Effective October 1, 2026 · 38 codes added, 10 retired, 800 payment limits changed vs Q3 2026.
Added in Q4 2026
| Code | Descriptor | Billing unit | Payment limit | Family | Replaces |
|---|---|---|---|---|---|
| 90616 | Flu vacc trivalent mRNA IM | — | $171.211 | CPT | — |
| J0014 | Cocaine hcl nasal (goprelto) | 1 MG | $1.825 | J-code | — |
| J0528 | Inj fosfomycin disodium 20mg | 20 MG | $0.633 | J-code | — |
| J0643 | Inj leucovorin calcium 1 mg | 1 MG | $0.054 | J-code | J0640 (50 MG, ×50 units) |
| J0644 | Inj, leucovorin cal (avyxa) | 1 MG | $2.625 | J-code | — |
| J0716 | Centruroides immune f(ab) | UP TO 120MG | $5,449.649 | J-code | — |
| J0841 | Inj crotalidae im f(ab')2 eq | 120 MG | $1,084.909 | J-code | back on the file after a gap |
| J0871 | Inj, daptomycin (endo) 1mg | 1 MG | $0.541 | J-code | — |
| J1289 | Narsoplimab-wuug, 1 mg | 1 MG | $105.441 | J-code | — |
| J1577 | Inj, qivigy, 100mg | 100 MG | $29.280 | J-code | — |
| J1737 | Inj meloxicam (azurity) 1mg | 1 MG | $1.060 | J-code | — |
| J1957 | Injection levetiracetam 5 mg | 5 MG | $0.013 | J-code | J1953 (10 MG, ×2 units) |
| J1958 | Inj levetirac sodi chlo 5 mg | 5 MG | $0.033 | J-code | — |
| J2361 | Inj depemokimab-ulaa 1 mg | 1 MG | $275.391 | J-code | — |
| J2374 | Apraclonidine hcl opht 0.1ml | 0.1 ML | $28.804 | J-code | — |
| J2789 | Riboflavin epioxa/hd<=2ml | UP TO 2 ML | $41,359.618 | J-code | — |
| J3268 | Injection, delafloxacin | 1 MG | $0.478 | J-code | — |
| J3404 | Inj zopapogene per ther dose | Per Therapeutic Dose | $119,675.512 | J-code | — |
| J3405 | Inj onase abepar-brve treat | Per treatment | $2,729,937.922 | J-code | — |
| J7524 | Mycophenol mofetil oral 5 mg | 5 MG | $0.002 | J-code | J7517 (250 MG, ×50 units) |
| J7526 | Inj mycophenola mofetil 5 mg | 5 MG | $0.200 | J-code | J7519 (10 MG, ×2 units) |
| J7529 | Mycop mofetil susp oral 5 mg | 5 MG | $0.034 | J-code | J7528 (100 MG, ×20 units) |
| J7530 | Mycophenolat (myhibbin) 5 mg | 5 MG | $0.115 | J-code | J7514 (100 MG, ×20 units) |
| J8541 | Oral, hemady, 0.25 mg | 0.25 MG | $0.375 | J-code | — |
| J9186 | Inj etoposide (avyxa), 1 mg | 1 MG | $4.240 | J-code | — |
| J9187 | Inj, etoposide, 1 mg | 1 MG | $0.094 | J-code | J9181 (10 MG, ×10 units) |
| J9191 | Inj fluorouracil (avyxa)10mg | 10 MG | $14.840 | J-code | — |
| J9192 | Inj, fluorouracil, 10 mg | 10 MG | $0.039 | J-code | J9190 (500 MG, ×50 units) |
| J9275 | Inj cosibelimab-ipdl, 2 mg | 2 MG | $21.989 | J-code | — |
| J9318 | Inj romidepsin non-lyo 0.1mg | 0.1 MG | $32.864 | J-code | back on the file after a gap |
| J9361 | Inj, efbemalenograstim alfa- | 0.5 MG | $121.429 | J-code | — |
| J9362 | Inj, trabectedin, 0.01 mg | 0.01 MG | $41.844 | J-code | J9352 (0.1 MG, ×10 units) |
| Q0166 | Granisetron hcl 1 mg oral | 1 MG | $0.774 | Q-code | — |
| Q2058 | Obecbtge autol up to 400 mil | Per Therapeutic Dose | $293,725.702 | Q-code | — |
| Q5161 | Inj, denosumab-kyqq, 1 mg | 1 MG | $27.509 | biosimilar (Q5) | — |
| Q5167 | Inj, denosumab-qbde, 1 mg | 1 MG | $7.681 | biosimilar (Q5) | — |
| Q5168 | Inj. nufymco, 0.1 mg | 0.1 MG | $26.384 | biosimilar (Q5) | — |
| Q5169 | Inj, armlupeg, 0.5 mg | 0.5 MG | $519.481 | biosimilar (Q5) | — |
Retired in Q4 2026
| Code | Descriptor (last quarter listed) | Billing unit | Bill instead |
|---|---|---|---|
| J0640 | Leucovorin calcium injection | 50 MG | J0643 (1 MG — ×50 units for the same dose) · branded: J0644 |
| J1953 | Levetiracetam injection | 10 MG | J1957 (5 MG — ×2 units for the same dose) |
| J7514 | Mycophenol (myhibbin) 100 mg | 100 MG | J7530 (5 MG — ×20 units for the same dose) |
| J7517 | Mycophenolate mofetil oral | 250 MG | J7524 (5 MG — ×50 units for the same dose) |
| J7519 | Inj. mycophenolate mofetil | 10 MG | J7526 (5 MG — ×2 units for the same dose) |
| J7528 | Mycophen mofetil for susp | 100 MG | J7529 (5 MG — ×20 units for the same dose) |
| J9181 | Etoposide injection | 10 MG | J9187 (1 MG — ×10 units for the same dose) · branded: J9186 |
| J9190 | Fluorouracil injection | 500 MG | J9192 (10 MG — ×50 units for the same dose) · branded: J9191 |
| J9352 | Injection trabectedin 0.1mg | 0.1 MG | J9362 (0.01 MG — ×10 units for the same dose) |
| J9394 | Inj, fulvestrant (fresenius) | 25 MG | — |
Largest payment-limit moves among covered drugs, Q4 2026
| Code | Descriptor | Q3 2026 | Q4 2026 | Change |
|---|---|---|---|---|
| J9305 | Inj. pemetrexed nos 10mg | $6.952 | $1.230 | -82.3% |
| J9263 | Oxaliplatin | $0.055 | $0.087 | +58.2% |
| J2778 | Ranibizumab injection | $51.090 | $26.384 | -48.4% |
| J9264 | Paclitaxel protein bound | $6.586 | $3.640 | -44.7% |
| J2506 | Inj pegfilgrast ex bio 0.5mg | $143.233 | $201.241 | +40.5% |
| J9041 | Injection, bortezomib, 0.1mg | $2.037 | $2.628 | +29.0% |
| J9060 | Cisplatin 10 mg injection | $2.130 | $2.497 | +17.2% |
| J0875 | Injection, dalbavancin | $11.293 | $9.439 | -16.4% |
| Q2050 | Doxorubicin inj 10mg | $116.605 | $97.823 | -16.1% |
| J9206 | Irinotecan injection | $1.851 | $1.569 | -15.2% |
Q3 2026
· 11 added, 9 retired
Effective July 1, 2026 · 11 codes added, 9 retired, 818 payment limits changed vs Q2 2026.
Added in Q3 2026
| Code | Descriptor | Billing unit | Payment limit | Family | Replaces |
|---|---|---|---|---|---|
| J0681 | Inj ceftobipole medocarl 3mg | 3 MG | $1.098 | J-code | — |
| J7674 | Methacholine chloride, neb | 1 MG | $1.942 | J-code | back on the file after a gap |
| J9053 | Inj belantamab mafodot blmf | 0.1 MG | $36.250 | J-code | — |
| J9062 | Inj amivantamab 5mg hyaluron | 5 MG | $40.743 | J-code | — |
| J9161 | Inj denileuk difti-cxdl 1mcg | 1 MCG | $12.826 | J-code | — |
| J9174 | Inj, docetaxel (beizray) 1mg | 1 MG | $46.808 | J-code | — |
| J9232 | Inj docetaxel (hospira) 1 mg | 1 MG | $0.512 | J-code | — |
| Q0234 | Inj, tocilizumab-bavi, 1mg | 1 MG | $6.327 | Q-code | — |
| Q0238 | Inj, tocilizumab-aazg, hospi | 1 MG | $5.581 | Q-code | — |
| Q5098 | Inj ustekinumab-srlf, 1 mg | 1 MG | $11.551 | biosimilar (Q5) | — |
| Q5160 | Inj, jobevne, 10 mg | 10 MG | $82.236 | biosimilar (Q5) | — |
Retired in Q3 2026
| Code | Descriptor (last quarter listed) | Billing unit | Bill instead |
|---|---|---|---|
| J0565 | Inj, bezlotoxumab, 10 mg | 10 MG | — |
| J1748 | Inj, zymfentra, 10 mg | 10 MG | — |
| J2840 | Inj, sebelipase alfa, 1 mg | 1 MG | — |
| J3403 | Revakinagene, per implant | PER IMPLANT | — |
| J7314 | Inj., yutiq, 0.01 mg | 0.01 MG | — |
| J9196 | Inj gemcitabine hcl (accord) | 200 MG | — |
| J9295 | Injection, necitumumab, 1 mg | 1 MG | — |
| J9296 | Inj pemetrexed (accord) 10mg | 10 mg | — |
| J9318 | Inj romidepsin non-lyo 0.1mg | 0.1 MG | re-listed in Q4 2026 |
Largest payment-limit moves among covered drugs, Q3 2026
| Code | Descriptor | Q2 2026 | Q3 2026 | Change |
|---|---|---|---|---|
| J9305 | Inj. pemetrexed nos 10mg | $4.038 | $6.952 | +72.2% |
| Q2050 | Doxorubicin inj 10mg | $71.861 | $116.605 | +62.3% |
| Q0138 | Ferumoxytol, non-esrd | $0.229 | $0.370 | +61.6% |
| J0583 | Bivalirudin | $0.124 | $0.166 | +33.9% |
| J9263 | Oxaliplatin | $0.078 | $0.055 | -29.5% |
| J0875 | Injection, dalbavancin | $15.003 | $11.293 | -24.7% |
| J2778 | Ranibizumab injection | $67.853 | $51.090 | -24.7% |
| J9267 | Paclitaxel injection | $0.147 | $0.112 | -23.8% |
| J2267 | Inj, mirikizumab-mrkz, 1 mg | $42.092 | $32.658 | -22.4% |
| J9206 | Irinotecan injection | $1.532 | $1.851 | +20.8% |
Q2 2026
· 20 added, 11 retired
Effective April 1, 2026 · 20 codes added, 11 retired, 778 payment limits changed vs Q1 2026.
Added in Q2 2026
| Code | Descriptor | Billing unit | Payment limit | Family | Replaces |
|---|---|---|---|---|---|
| J0463 | Inj atropine (fresenius te) | 0.01 MG | $0.014 | J-code | — |
| J0759 | Inj, clevidipine, 1 mg | 1 MG | $2.844 | J-code | — |
| J1164 | Inj diltiazem in 0.72% nacl | 0.5 MG | $0.179 | J-code | — |
| J1553 | Inj yimmugo 100 mg | 100 MG | $24.323 | J-code | — |
| J1612 | Inj glucagon (gvoke) 0.01 mg | 0.01 MG | $2.365 | J-code | — |
| J2545 | Pentamidine non-comp unit | 300 MG | $73.565 | J-code | back on the file after a gap |
| J8502 | Inj, aponvie, 1 mg | 1 MG | $1.953 | J-code | — |
| J8515 | Cabergoline, oral 0.25mg | 0.25 MG | $0.154 | J-code | — |
| J9183 | Gemcitabine intravesical sys | 225 MG | $73,088.260 | J-code | — |
| J9184 | Inj gemcitabin (avyxa) 200mg | 200 MG | $410.439 | J-code | — |
| J9277 | Pembrolizumab 1mg berahyalur | 1 MG | $32.129 | J-code | — |
| J9278 | Inj, carboplatin (avyxa) | 1 MG | $5.242 | J-code | — |
| J9282 | Mitomycin intravesical inst | 1 MG | $278.332 | J-code | — |
| J9601 | Inj linvoseltamab-gcpt 1 mg | 1 MG | $99.502 | J-code | — |
| Q0237 | Inj, tocilizumab-anoh, hospi | 1 MG | $4.920 | Q-code | — |
| Q5134 | Inj, tyruko, 1 mg | 1 MG | $24.321 | biosimilar (Q5) | — |
| Q5156 | Inj, tocilizumab-anoh, 1 mg | 1 MG | $4.635 | biosimilar (Q5) | — |
| Q5157 | Inj, denosumab-bmwo, 1 mg | 1 MG | $26.209 | biosimilar (Q5) | — |
| Q5158 | Inj, denosumab-bnht, 1 mg | 1 MG | $29.797 | biosimilar (Q5) | — |
| Q5162 | Inj, den (bil/bil), bio, 1mg | 1 MG | $15.841 | biosimilar (Q5) | — |
Retired in Q2 2026
| Code | Descriptor (last quarter listed) | Billing unit | Bill instead |
|---|---|---|---|
| 90586 | Bcg vaccine intravesical | 1 EACH | — |
| 90759 | Hep b vac 3ag 10mcg 3 dos im | 10 MCG | — |
| J0841 | Inj crotalidae im f(ab')2 eq | 120 MG | re-listed in Q4 2026 |
| J0893 | Inj, decitabine (sun pharma) | 1 MG | — |
| J2313 | Inj, naloxone (zimhi) 0.01mg | 0.01 MG | — |
| J3471 | Ovine, up to 999 usp units | 1 USP UNIT | — |
| J7674 | Methacholine chloride, neb | 1 MG | re-listed in Q3 2026 |
| J8670 | Rolapitant, oral, 1mg | 1 MG | — |
| J9202 | Goserelin acetate implant | 3.6 MG | — |
| J9323 | Inj pemetrexed ditromethamin | 10 mg | — |
| Q4074 | Iloprost non-comp unit dose | UP TO 20 MCG | — |
Largest payment-limit moves among covered drugs, Q2 2026
| Code | Descriptor | Q1 2026 | Q2 2026 | Change |
|---|---|---|---|---|
| J0883 | Argatroban nonesrd use 1mg | $0.609 | $1.013 | +66.3% |
| J9263 | Oxaliplatin | $0.047 | $0.078 | +66.0% |
| J9267 | Paclitaxel injection | $0.099 | $0.147 | +48.5% |
| Q0138 | Ferumoxytol, non-esrd | $0.360 | $0.229 | -36.4% |
| Q2050 | Doxorubicin inj 10mg | $104.008 | $71.861 | -30.9% |
| J9264 | Paclitaxel protein bound | $8.184 | $6.020 | -26.4% |
| J0878 | Daptomycin injection | $0.028 | $0.034 | +21.4% |
| J0583 | Bivalirudin | $0.157 | $0.124 | -21.0% |
| J9041 | Injection, bortezomib, 0.1mg | $2.678 | $2.253 | -15.9% |
| J0888 | Epoetin beta non esrd | $1.215 | $1.033 | -15.0% |
Q1 2026
· 21 added, 156 retired
Effective January 1, 2026 · 21 codes added, 156 retired, 778 payment limits changed vs Q4 2025.
Added in Q1 2026
| Code | Descriptor | Billing unit | Payment limit | Family | Replaces |
|---|---|---|---|---|---|
| J0162 | Inj epinephrine (fresenius) | 0.1 MG | $0.455 | J-code | — |
| J0164 | Epinephrine in nacl (baxter) | 0.1 MG | $0.941 | J-code | — |
| J0458 | Aztreonam/avibactam 10 mg | 10 MG | $1.678 | J-code | — |
| J1307 | Inj, crovalimab-akkz, 10 mg | 10 MG | $551.512 | J-code | — |
| J1597 | Inj glycopyrrolate, glyrx-pf | 0.1 MG | $1.276 | J-code | — |
| J1837 | Inj, posaconazole, 1 mg | 1 MG | $0.346 | J-code | — |
| J2516 | Pentamidine non-comp unit | 1 MG | $0.235 | J-code | — |
| J2596 | Vasopressin (long grove) 1 u | 1 UNIT | $1.790 | J-code | — |
| J3376 | Inj vancomycin (hikma) 10mg | 10 MG | $0.019 | J-code | — |
| J3379 | Inj, valproate sod, 5 mg | 5 MG | $0.045 | J-code | — |
| J3403 | Revakinagene, per implant | PER IMPLANT | $265,000.000 | J-code | — |
| J7174 | Injection fitusiran 0.04 mg | 0.04 MG | $132.620 | J-code | — |
| J7514 | Mycophenol (myhibbin) 100 mg | 100 MG | $2.243 | J-code | — |
| J7528 | Mycophen mofetil for susp | 100 MG | $0.240 | J-code | — |
| J9256 | Inj, nipocalimab-aahu, 3 mg | 3 MG | $32.743 | J-code | — |
| J9326 | Telisotuzumab vedotin-tllv | 1 MG | $145.871 | J-code | — |
| J9341 | Inj thiotepa (tepylute) 1 mg | 1 MG | $38.550 | J-code | — |
| Q5136 | Inj. denosumab-bbdz, 1 mg | 1 MG | $28.230 | biosimilar (Q5) | — |
| Q5148 | Inj, nyposi 1 mcg | 1 MCG | $0.997 | biosimilar (Q5) | — |
| Q5151 | Inj, eculizumab-aagh, 2 mg | 2 MG | $31.672 | biosimilar (Q5) | — |
| Q5152 | Inj, eculizumab-aeeb, 2 mg | 2 MG | $42.347 | biosimilar (Q5) | — |
Retired in Q1 2026
| Code | Descriptor (last quarter listed) | Billing unit | Bill instead |
|---|---|---|---|
| 90670 | Pcv13 vaccine im | 0.5 ML | — |
| J0172 | Inj, aducanumab-avwa, 2 mg | 2 MG | — |
| J0287 | Amphotericin b lipid complex | 10 MG | — |
| J2545 | Pentamidine non-comp unit | 300 MG | re-listed in Q2 2026 |
| Q4101 | Apligraf | 1 SQ CM | — |
| Q4102 | Oasis wound matrix | 1 SQ CM | — |
| Q4103 | Oasis burn matrix | 1 SQ CM | — |
| Q4104 | Integra bmwd | 1 SQ CM | — |
| Q4105 | Integra drt or omnigraft | 1 SQ CM | — |
| Q4108 | Integra matrix | 1 SQ CM | — |
| Q4110 | Primatrix | 1 SQ CM | — |
| Q4111 | Gammagraft | 1 SQ CM | — |
| Q4114 | Integra flowable wound matri | 1 CC | — |
| Q4115 | Alloskin | 1 SQ CM | — |
| Q4118 | Matristem micromatrix | 1 MG | — |
| Q4121 | Theraskin | 1 SQ CM | — |
| Q4123 | Alloskin | 1 SQ CM | — |
| Q4124 | Oasis tri-layer wound matrix | 1 SQ CM | — |
| Q4126 | Memoderm/derma/tranz/integup | 1 SQ CM | — |
| Q4127 | Talymed | 1 SQ CM | — |
| Q4128 | Flexhd/allopatchhd/sq cm | 1 SQ CM | — |
| Q4132 | Grafix core, grafixpl core | 1 SQ CM | — |
| Q4133 | Grafix stravix prime pl sqcm | 1 SQ CM | — |
| Q4137 | Amnioexcel biodexcel 1sq cm | 1 SQ CM | — |
| Q4138 | Biodfence dryflex, 1cm | 1 SQ CM | — |
| Q4140 | Biodfence 1cm | 1 SQ CM | — |
| Q4141 | Alloskin ac, 1 cm | 1 SQ CM | — |
| Q4143 | Repriza, 1cm | 1 SQ CM | — |
| Q4145 | Epifix, inj, 1mg | 1 MG | — |
| Q4148 | Neox neox rt or clarix cord | 1 SQ CM | — |
| Q4150 | Allowrap ds or dry 1 sq cm | 1 SQ CM | — |
| Q4151 | Amnioband, guardian 1 sq cm | 1 SQ CM | — |
| Q4152 | Dermapure 1 square cm | 1 SQ CM | — |
| Q4153 | Dermavest, plurivest sq cm | 1 SQ CM | — |
| Q4154 | Biovance 1 square cm | 1 SQ CM | — |
| Q4155 | Neoxflo or clarixflo 1 mg | 1 MG | — |
| Q4156 | Neox 100 or clarix 100 | 1 SQ CM | — |
| Q4158 | Kerecis omega3, per sq cm | 1 SQ CM | — |
| Q4159 | Affinity1 square cm | 1 SQ CM | — |
| Q4160 | Nushield 1 square cm | 1 SQ CM | — |
| Q4161 | Bio-connekt per square cm | 1 SQ CM | — |
| Q4163 | Woundex, bioskin, per sq cm | 1 SQ CM | — |
| Q4164 | Helicoll, per square cm | 1 SQ CM | — |
| Q4166 | Cytal, per square centimeter | 1 SQ CM | — |
| Q4169 | Artacent wound, per sq cm | 1 SQ CM | — |
| Q4170 | Cygnus, per sq cm | 1 SQ CM | — |
| Q4171 | Interfyl, 1 mg | 1 MG | — |
| Q4173 | Palingen or palingen xplus | 1 SQ CM | — |
| Q4175 | Miroderm | 1 SQ CM | — |
| Q4178 | Floweramniopatch, per sq cm | 1 SQ CM | — |
| Q4180 | Revita, per sq cm | 1 SQ CM | — |
| Q4184 | Cellesta or duo per sq cm | 1 SQ CM | — |
| Q4186 | Epifix 1 sq cm | 1 SQ CM | — |
| Q4187 | Epicord 1 sq cm | 1 SQ CM | — |
| Q4188 | Amnioarmor 1 sq cm | 1 SQ CM | — |
| Q4190 | Artacent ac 1 sq cm | 1 SQ CM | — |
| Q4191 | Restorigin 1 sq cm | 1 SQ CM | — |
| Q4193 | Coll-e-derm 1 sq cm | 1 SQ CM | — |
| Q4194 | Novachor 1 sq cm | 1 SQ CM | — |
| Q4195 | Puraply 1 sq cm | 1 SQ CM | — |
| Q4196 | Puraply am 1 sq cm | 1 SQ CM | — |
| Q4197 | Puraply xt 1 sq cm | 1 SQ CM | — |
| Q4199 | Cygnus matrix, per sq cm | 1 SQ CM | — |
| Q4201 | Matrion 1 sq cm | 1 SQ CM | — |
| Q4203 | Derma-gide, 1 sq cm | 1 SQ CM | — |
| Q4204 | Xwrap 1 sq cm | 1 SQ CM | — |
| Q4205 | Membrane graft or wrap sq cm | 1 SQ CM | — |
| Q4217 | Woundfix biowound plus xplus | 1 SQ CM | — |
| Q4221 | Amniowrap2 per sq cm | 1 SQ CM | — |
| Q4222 | Progenamatrix, per sq cm | 1 SQ CM | — |
| Q4225 | Amnio or derma tl, per sq cm | 1 SQ CM | — |
| Q4227 | Amniocore per sq cm | 1 SQ CM | — |
| Q4229 | Cogenex amnio memb per sq cm | 1 SQ CM | — |
| Q4232 | Corplex, per sq cm | 1 SQ CM | — |
| Q4234 | Xcellerate, per sq cm | 1 SQ CM | — |
| Q4235 | Amniorepair or altiply sq cm | 1 SQ CM | — |
| Q4236 | Carepatch per sq cm | 1 SQ CM | — |
| Q4238 | Derm-maxx, per sq cm | 1 SQ CM | — |
| Q4239 | Amnio-maxx or lite per sq cm | 1 SQ CM | — |
| Q4248 | Dermacyte amn mem allo sq cm | 1 SQ CM | — |
| Q4249 | Amniply, per sq cm | 1 SQ CM | — |
| Q4250 | Amnioamp-mp per sq cm | 1 SQ CM | — |
| Q4252 | Vendaje, per square centimet | 1 SQ CM | — |
| Q4253 | Zenith amniotic membrane psc | 1 SQ CM | — |
| Q4256 | Mlg complet, per sq cm | 1 SQ CM | — |
| Q4257 | Relese, per sq cm | 1 SQ CM | — |
| Q4258 | Enverse, per sq cm | 1 SQ CM | — |
| Q4259 | Celera per sq cm | 1 SQ CM | — |
| Q4262 | Dual layer impax, per sq cm | 1 SQ CM | — |
| Q4263 | Surgraft tl, per sq cm | 1 SQ CM | — |
| Q4264 | Cocoon membrane, per sq cm | 1 SQ CM | — |
| Q4265 | Neostim tl per sq cm | 1 SQ CM | — |
| Q4266 | Neostim per sq cm | 1 SQ CM | — |
| Q4267 | Neostim dl per sq cm | 1 SQ CM | — |
| Q4268 | Surgraft ft per sq cm | 1 SQ CM | — |
| Q4269 | Surgraft xt per sq cm | 1 SQ CM | — |
| Q4270 | Complete sl per sq cm | 1 SQ CM | — |
| Q4271 | Complete ft per sq cm | 1 SQ CM | — |
| Q4274 | Esano ac, per sq cm | 1 SQ CM | — |
| Q4275 | Esano aca, per sq cm | 1 SQ CM | — |
| Q4276 | Orion, per sq cm | 1 SQ CM | — |
| Q4278 | Epieffect, per sq cm | 1 SQ CM | — |
| Q4279 | Vendaje ac, per sq cm | 1 SQ CM | — |
| Q4280 | Xcell amnio matrix per sq cm | 1 SQ CM | — |
| Q4281 | Barrera slor dl per sq cm | 1 SQ CM | — |
| Q4282 | Cygnus dual per sq cm | 1 SQ CM | — |
| Q4283 | Biovance tri or 3l, sq cm | 1 SQ CM | — |
| Q4289 | Revoshield+ amnio, per sq cm | 1 SQ CM | — |
| Q4290 | Membrane wrap hydr per sq cm | 1 SQ CM | — |
| Q4293 | Acesso dl, per sq cm | 1 SQ CM | — |
| Q4294 | Amnio quad-core, per sq cm | 1 SQ CM | — |
| Q4295 | Amnio tri-core, per sq cm | 1 SQ CM | — |
| Q4296 | Rebound matrix, per sq cm | 1 SQ CM | — |
| Q4297 | Emerge matrix, per sq cm | 1 SQ CM | — |
| Q4298 | Amnicore pro, per sq cm | 1 SQ CM | — |
| Q4299 | Amnicore pro+, per sq cm | 1 SQ CM | — |
| Q4300 | Acesso tl, per sq cm | 1 SQ CM | — |
| Q4301 | Activate matrix, per sq cm | 1 SQ CM | — |
| Q4302 | Complete aca, per sq cm | 1 SQ CM | — |
| Q4303 | Complete aa, per sq cm | 1 SQ CM | — |
| Q4304 | Grafix plus, per sq cm | 1 SQ CM | — |
| Q4309 | Via matrix, per sq cm | 1 SQ CM | — |
| Q4310 | Procenta, per 100 mg | 100 MG | — |
| Q4312 | Acesso ac, per sq cm | 1 SQ CM | — |
| Q4313 | Dermabind fm, per sq cm | 1 SQ CM | — |
| Q4314 | Reeva, per sq cm | 1 SQ CM | — |
| Q4316 | Amchoplast, per sq cm | 1 SQ CM | — |
| Q4317 | Vitograft, per sq cm | 1 SQ CM | — |
| Q4319 | Sanograft, per sq cm | 1 SQ CM | — |
| Q4320 | Pellograft, per sq cm | 1 SQ CM | — |
| Q4321 | Renograft, per sq cm | 1 SQ CM | — |
| Q4322 | Caregraft, per sq cm | 1 SQ CM | — |
| Q4323 | Alloply, per sq cm | 1 SQ CM | — |
| Q4325 | Acapatch, per sq cm | 1 SQ CM | — |
| Q4326 | Woundplus, per sq cm | 1 SQ CM | — |
| Q4328 | Most, per sq cm | 1 SQ CM | — |
| Q4331 | Axolotl graft, per sq cm | 1 SQ CM | — |
| Q4332 | Axolotl dualgraft, per sq cm | 1 SQ CM | — |
| Q4339 | Artacent vericlen, per sq cm | 1 SQ CM | — |
| Q4340 | Simpligraft, per sq cm | 1 SQ CM | — |
| Q4341 | Simplimax, per sq cm | 1 SQ CM | — |
| Q4342 | Theramend, per sq cm | 1 SQ CM | — |
| Q4343 | Dermacyte ac matrx per sq cm | 1 SQ CM | — |
| Q4344 | Tri membrane wrap, per sq cm | 1 SQ CM | — |
| Q4345 | Matrix hd allogrft per sq cm | 1 SQ CM | — |
| Q4346 | Shelter dm matrix per sq cm | 1 SQ CM | — |
| Q4347 | Rampart dl matrix per sq cm | 1 SQ CM | — |
| Q4348 | Sentry sl matrix per sq cm | 1 SQ CM | — |
| Q4350 | Palisade dm matrix per sq cm | 1 SQ CM | — |
| Q4353 | Xceed tl matrix per sq cm | 1 SQ CM | — |
| Q4355 | Abio xpl abio xpl hy p sq cm | 1 SQ CM | — |
| Q4357 | Xwrap plus, per sq cm | 1 SQ CM | — |
| Q4358 | Xwrap dual, per sq cm | 1 SQ CM | — |
| Q4359 | Choriply, per sq cm | 1 SQ CM | — |
| Q4361 | Epixpress, per sq cm | 1 SQ CM | — |
| Q4367 | Amniocore sl, per sq cm | 1 SQ CM | — |
Largest payment-limit moves among covered drugs, Q1 2026
| Code | Descriptor | Q4 2025 | Q1 2026 | Change |
|---|---|---|---|---|
| J9263 | Oxaliplatin | $0.083 | $0.047 | -43.4% |
| J2506 | Inj pegfilgrast ex bio 0.5mg | $89.344 | $122.837 | +37.5% |
| J9267 | Paclitaxel injection | $0.135 | $0.099 | -26.7% |
| J2919 | Inj, methylpred sod succ 5mg | $0.210 | $0.264 | +25.7% |
| J2778 | Ranibizumab injection | $86.384 | $65.443 | -24.2% |
| J0883 | Argatroban nonesrd use 1mg | $0.796 | $0.609 | -23.5% |
| J9264 | Paclitaxel protein bound | $10.543 | $8.184 | -22.4% |
| J1652 | Fondaparinux sodium | $0.723 | $0.877 | +21.3% |
| J9045 | Carboplatin injection | $2.471 | $2.929 | +18.5% |
| J9305 | Inj. pemetrexed nos 10mg | $4.355 | $3.594 | -17.5% |
Q4 2025
· 44 added, 2 retired
Effective October 1, 2025 · 44 codes added, 2 retired, 884 payment limits changed vs Q3 2025.
Added in Q4 2025
| Code | Descriptor | Billing unit | Payment limit | Family | Replaces |
|---|---|---|---|---|---|
| 91323 | SARSCOV2 VAC 10 MCG/0.2ML IM | 10 MCG | $201.913 | CPT | — |
| J0163 | Epinephrine in nacl (endo) | 0.1 MG | $0.974 | J-code | — |
| J0462 | Atropine sulf, nte, 0.01 mg | 0.01 MG | $0.135 | J-code | — |
| J0582 | Bivalirudin (endo) 1 mg | 1 MG | $0.139 | J-code | — |
| J0614 | Inj, treosulfan, 50 mg | 50 MG | $32.330 | J-code | — |
| J0738 | Hiv prep, inj, lenacapavir | 1 MG | $16.133 | J-code | — |
| J0752 | Hiv prep, oral lenacapavir | 300 MG | $449.030 | J-code | — |
| J0901 | Vadadustat oral 1mg for esrd | 1 MG | $0.143 | J-code | — |
| J1809 | Inj, fosdenopterin, 0.1mg | 0.1 MG | $16.971 | J-code | — |
| J2151 | Inj, mannitol, 250 mg | 250 MG | $0.061 | J-code | — |
| J2291 | Inj, nafcillin (baxter) 20mg | 20 MG | $0.150 | J-code | — |
| J2428 | Inj, erzofri, 1 mg | 1 MG | $16.764 | J-code | — |
| J3402 | Inj. remestemcel-l-rknd/ td | Per Therapeutic Dose | $205,640.000 | J-code | — |
| J7173 | Inj. concizumab-mtci, 0.5 mg | 0.5 MG | $86.405 | J-code | — |
| J7356 | Inj foscarb/foslevodopa 5 mg | 0.25 MG - 5 MG | $0.706 | J-code | — |
| J9011 | Datopotamab deruxtecan, 1 mg | 1 MG | $51.558 | J-code | — |
| J9038 | Inj axatilimab-csfr 0.1 mg | 0.1 MG | $55.650 | J-code | — |
| J9054 | Inj bortezomib boruzu 0.1 mg | 0.1 MG | $26.150 | J-code | — |
| J9289 | Inj nivolumab 2 mg hyaluron | 2 MG | $27.362 | J-code | — |
| J9382 | Inj zenocutuzumab-zbco 1 mg | 1 MG | $32.910 | J-code | — |
| Q4268 | Surgraft ft per sq cm | 1 SQ CM | $452.707 | Q-code | — |
| Q4269 | Surgraft xt per sq cm | 1 SQ CM | $1,804.956 | Q-code | back on the file after a gap |
| Q4312 | Acesso ac, per sq cm | 1 SQ CM | $2,411.764 | Q-code | — |
| Q4314 | Reeva, per sq cm | 1 SQ CM | $2,332.000 | Q-code | — |
| Q4317 | Vitograft, per sq cm | 1 SQ CM | $4,770.000 | Q-code | — |
| Q4319 | Sanograft, per sq cm | 1 SQ CM | $2,809.000 | Q-code | back on the file after a gap |
| Q4320 | Pellograft, per sq cm | 1 SQ CM | $103.026 | Q-code | — |
| Q4321 | Renograft, per sq cm | 1 SQ CM | $3,816.000 | Q-code | — |
| Q4340 | Simpligraft, per sq cm | 1 SQ CM | $1,377.894 | Q-code | — |
| Q4345 | Matrix hd allogrft per sq cm | 1 SQ CM | $2,650.000 | Q-code | — |
| Q4346 | Shelter dm matrix per sq cm | 1 SQ CM | $3,663.787 | Q-code | — |
| Q4347 | Rampart dl matrix per sq cm | 1 SQ CM | $3,099.433 | Q-code | — |
| Q4348 | Sentry sl matrix per sq cm | 1 SQ CM | $2,034.877 | Q-code | — |
| Q4350 | Palisade dm matrix per sq cm | 1 SQ CM | $3,608.093 | Q-code | — |
| Q4353 | Xceed tl matrix per sq cm | 1 SQ CM | $4,148.840 | Q-code | — |
| Q4355 | Abio xpl abio xpl hy p sq cm | 1 SQ CM | $2,835.716 | Q-code | — |
| Q4358 | Xwrap dual, per sq cm | 1 SQ CM | $5,893.344 | Q-code | — |
| Q4359 | Choriply, per sq cm | 1 SQ CM | $2,779.320 | Q-code | — |
| Q5099 | Inj ustekinumab-stba, 1 mg | 1 MG | $12.642 | biosimilar (Q5) | — |
| Q5100 | Inj ustekinumab-kfce, 1 mg | 1 MG | $24.979 | biosimilar (Q5) | — |
| Q5138 | Inj, wezlana, iv, 1 mg | 1 MG | $11.645 | biosimilar (Q5) | — |
| Q9997 | Ustekinumab-ttwe iv inj 1 mg | 1 MG | $9.287 | Q-code | — |
| Q9998 | Inj ustekinumab-aekn, 1 mg | 1 MG | $37.520 | Q-code | — |
| Q9999 | Inj ustekinumab-aauz 1 mg | 1 MG | $33.088 | Q-code | — |
Retired in Q4 2025
| Code | Descriptor (last quarter listed) | Billing unit | Bill instead |
|---|---|---|---|
| 91318 | SARSCOV2 VAC 3MCG TRS-SUC IM | 0.3 ML | — |
| J2150 | Mannitol injection | 50 ML | — |
Largest payment-limit moves among covered drugs, Q4 2025
| Code | Descriptor | Q3 2025 | Q4 2025 | Change |
|---|---|---|---|---|
| J9041 | Injection, bortezomib, 0.1mg | $1.589 | $2.791 | +75.6% |
| J2506 | Inj pegfilgrast ex bio 0.5mg | $58.399 | $89.344 | +53.0% |
| J9267 | Paclitaxel injection | $0.106 | $0.135 | +27.4% |
| J9206 | Irinotecan injection | $1.397 | $1.751 | +25.3% |
| J2919 | Inj, methylpred sod succ 5mg | $0.259 | $0.210 | -18.9% |
| J9060 | Cisplatin 10 mg injection | $1.948 | $2.294 | +17.8% |
| J9045 | Carboplatin injection | $2.111 | $2.471 | +17.1% |
| J9305 | Inj. pemetrexed nos 10mg | $3.734 | $4.355 | +16.6% |
| J1437 | Inj. fe derisomaltose 10 mg | $18.951 | $22.018 | +16.2% |
| J9264 | Paclitaxel protein bound | $12.122 | $10.543 | -13.0% |
Q3 2025
· 40 added, 12 retired
Effective July 1, 2025 · 40 codes added, 12 retired, 856 payment limits changed vs Q2 2025.
Added in Q3 2025
| Code | Descriptor | Billing unit | Payment limit | Family | Replaces |
|---|---|---|---|---|---|
| J0165 | Inj epinephrine nos 0.1 mg | 0.1 MG | $0.580 | J-code | — |
| J0166 | Inj epinephrine (bpi) | 0.1 MG | $2.282 | J-code | — |
| J0167 | Inj epinephrine (hospira) | 0.1 MG | $0.737 | J-code | — |
| J0168 | Epinephrine (intl med sys) | 0.1 MG | $2.176 | J-code | — |
| J0169 | Inj epinephrine (adrenalin) | 0.1 MG | $1.320 | J-code | — |
| J0616 | Inj metoprolol tartrate 1 mg | 1 MG | $0.134 | J-code | — |
| J1072 | Inj, testosterone, azmiro | 1 MG | $1.325 | J-code | — |
| J1163 | Inj, diltiazem hcl, 0.5 mg | 0.5 MG | $0.037 | J-code | — |
| J1326 | Inj, zolbetuximab-clzb, 2 mg | 2 MG | $33.557 | J-code | — |
| J1749 | Inj, iloprost, 0.1 mcg | 0.1 MCG | $5.713 | J-code | — |
| J2290 | Inj, nafcillin sodium, 20 mg | 20 MG | $0.057 | J-code | — |
| J2312 | Inj naloxone hcl nos, 0.01mg | 0.01 MG | $0.068 | J-code | — |
| J2313 | Inj, naloxone (zimhi) 0.01mg | 0.01 MG | $0.015 | J-code | — |
| J3373 | Inj, vancomycin hcl, 10 mg | 10 MG | $0.031 | J-code | — |
| J3374 | Inj, vancomycin (mylan) 10mg | 10 MG | $0.121 | J-code | — |
| J3375 | Inj vancomycin (xellia) 10mg | 10 MG | $0.134 | J-code | — |
| J7172 | Inj marstacim-hncq, 0.5 mg | 0.5 MG | $50.714 | J-code | — |
| J8611 | Oral methotrexate (jylamvo) | 2.5 MG | $18.528 | J-code | — |
| J8612 | Oral methotrexate (xatmep) | 2.5 MG | $22.659 | J-code | — |
| J9076 | Inj, cyclophos (baxter) 5mg | 5 MG | $5.028 | J-code | — |
| J9276 | Inj zanidatamab-hrii, 2 mg | 2 MG | $25.080 | J-code | — |
| J9292 | Inj, pemetrexed dipotassium | 10 MG | $83.284 | J-code | — |
| J9318 | Inj romidepsin non-lyo 0.1mg | 0.1 MG | $28.517 | J-code | — |
| J9329 | Inj, tislelizumab-jsgr | 1 MG | $57.416 | J-code | — |
| J9342 | Inj thiotepa nos 1 mg | 1 MG | $12.236 | J-code | — |
| Q2057 | Afamitresgene autoleucel | PER THERAPEUTIC DOSE | $770,620.000 | Q-code | — |
| Q4145 | Epifix, inj, 1mg | 1 MG | $19.478 | Q-code | — |
| Q4169 | Artacent wound, per sq cm | 1 SQ CM | $2,220.572 | Q-code | — |
| Q4249 | Amniply, per sq cm | 1 SQ CM | $1,789.545 | Q-code | — |
| Q4316 | Amchoplast, per sq cm | 1 SQ CM | $4,415.969 | Q-code | — |
| Q4326 | Woundplus, per sq cm | 1 SQ CM | $1,082.950 | Q-code | — |
| Q4331 | Axolotl graft, per sq cm | 1 SQ CM | $1,637.549 | Q-code | — |
| Q4339 | Artacent vericlen, per sq cm | 1 SQ CM | $2,055.340 | Q-code | — |
| Q4341 | Simplimax, per sq cm | 1 SQ CM | $3,071.281 | Q-code | — |
| Q4342 | Theramend, per sq cm | 1 SQ CM | $2,127.108 | Q-code | — |
| Q4344 | Tri membrane wrap, per sq cm | 1 SQ CM | $2,689.477 | Q-code | — |
| Q4357 | Xwrap plus, per sq cm | 1 SQ CM | $4,770.000 | Q-code | — |
| Q4361 | Epixpress, per sq cm | 1 SQ CM | $1,590.000 | Q-code | — |
| Q4367 | Amniocore sl, per sq cm | 1 SQ CM | $530.000 | Q-code | — |
| Q5146 | Inj, hercessi, 10 mg | 10 MG | $76.181 | biosimilar (Q5) | — |
Retired in Q3 2025
| Code | Descriptor (last quarter listed) | Billing unit | Bill instead |
|---|---|---|---|
| J0171 | Adrenalin epinephrine inject | 0.1 MG | — |
| J0173 | Inj, epinephrine (belcher) | 0.1 MG | — |
| J1744 | Icatibant injection | 1 MG | — |
| J2310 | Inj naloxone hydrochloride | 1 MG | — |
| J2311 | Inj, naloxone hcl (zimhi) | 1 MG | — |
| J3370 | Vancomycin hcl injection | 500 MG | — |
| J3371 | Inj, vancomycin hcl (mylan) | 500 MG | — |
| J3372 | Inj, vancomycin hcl (xellia) | 500 MG | — |
| J9340 | Thiotepa injection | 15 MG | — |
| Q4231 | Corplex p, per cc | 1 CC | — |
| Q4269 | Surgraft xt per sq cm | 1 SQ CM | re-listed in Q4 2025 |
| Q4319 | Sanograft, per sq cm | 1 SQ CM | re-listed in Q4 2025 |
Largest payment-limit moves among covered drugs, Q3 2025
| Code | Descriptor | Q2 2025 | Q3 2025 | Change |
|---|---|---|---|---|
| J2506 | Inj pegfilgrast ex bio 0.5mg | $19.981 | $58.399 | +192.3% |
| J9263 | Oxaliplatin | $0.049 | $0.091 | +85.7% |
| Q5128 | Inj, cimerli, 0.1 mg | $146.761 | $86.513 | -41.1% |
| J9041 | Injection, bortezomib, 0.1mg | $2.498 | $1.589 | -36.4% |
| J9060 | Cisplatin 10 mg injection | $2.860 | $1.948 | -31.9% |
| J9045 | Carboplatin injection | $2.930 | $2.111 | -28.0% |
| Q2050 | Doxorubicin inj 10mg | $150.409 | $109.284 | -27.3% |
| J0883 | Argatroban nonesrd use 1mg | $0.950 | $0.739 | -22.2% |
| J1652 | Fondaparinux sodium | $0.855 | $0.719 | -15.9% |
| J9267 | Paclitaxel injection | $0.126 | $0.106 | -15.9% |
Q2 2025
· 72 added, 6 retired
Effective April 1, 2025 · 72 codes added, 6 retired, 793 payment limits changed vs Q1 2025.
Added in Q2 2025
| Code | Descriptor | Billing unit | Payment limit | Family | Replaces |
|---|---|---|---|---|---|
| J0138 | Inj acetaminoph 10mg/ibu 3mg | 10 MG/3MG | $0.218 | J-code | — |
| J0281 | Inj aminocaproic acid 1 gram | 1 GM | $1.303 | J-code | — |
| J0287 | Amphotericin b lipid complex | 10 MG | $10.299 | J-code | — |
| J0589 | Inj daxibotulinumtoxina-lanm | 1 UNIT | $2.992 | J-code | — |
| J0593 | Inj., lanadelumab-flyo, 1 mg | 1 mg | $84.802 | J-code | — |
| J0870 | Injection, imetelstat, 1 mg | 1 MG | $55.510 | J-code | — |
| J0883 | Argatroban nonesrd use 1mg | 1 MG | $0.950 | J-code | — |
| J0893 | Inj, decitabine (sun pharma) | 1 MG | $0.777 | J-code | — |
| J0898 | Argatroban nonesrd (auromed) | 1 MG | $1.338 | J-code | — |
| J0899 | Argatroban dialysis, auromed | 1 MG | $1.338 | J-code | — |
| J1271 | Inj doxycycline hyclate 1 mg | 1 MG | $0.120 | J-code | — |
| J1299 | Inj, eculizumab, 2 mg | 2 MG | $44.809 | J-code | — |
| J1308 | Inj, famotidine, 0.25 mg | 0.25 MG | $0.008 | J-code | — |
| J1434 | Inj, focinvez, 1mg | 1 MG | $3.021 | J-code | — |
| J1744 | Icatibant injection | 1 MG | $125.317 | J-code | — |
| J1790 | Droperidol injection | up to 5 MG | $8.565 | J-code | — |
| J1808 | Inj, folic acid, 0.1 mg | 0.1 MG | $0.063 | J-code | — |
| J1938 | Inj, furosemide, 1 mg | 1 MG | $0.020 | J-code | — |
| J2246 | Inj, micafungin (baxter) | 1 MG | $0.638 | J-code | — |
| J2351 | Inj ocrelizumab 1mg hya-ocsq | 1 MG | $45.187 | J-code | — |
| J2371 | Inj phenylephrine hcl 20 mcg | 20 MCG | $0.002 | J-code | — |
| J2468 | Inj, palonosetron (posfrea) | 25 MCG | $59.905 | J-code | — |
| J2502 | Inj, pasireotide long acting | 1 MG | $526.942 | J-code | — |
| J2804 | Inj, rifampin, 1 mg | 1 MG | $0.142 | J-code | — |
| J2865 | Inj sulfameth/trim 5 mg/1 mg | 5MG-1MG | $0.056 | J-code | — |
| J3300 | Triamcinolone a inj prs-free | 1 MG | $24.516 | J-code | — |
| J3316 | Inj., triptorelin xr 3.75 mg | 3.75 MG | $3,506.041 | J-code | — |
| J3471 | Ovine, up to 999 usp units | 1 USP UNIT | $0.499 | J-code | — |
| J7355 | Inj travoprost intra impl | 1 MCG | $194.411 | J-code | — |
| J7521 | Tacrolim granules oral susp | 0.1 MG | $1.334 | J-code | — |
| J7601 | Ensifentrine inh 3 mg | 3 MG | $52.117 | J-code | — |
| J9024 | Inj atezolizumb 5mg hya-tqjs | 5 MG | $30.876 | J-code | — |
| J9026 | Inj, tarlatamab-dlle, 1 mg | 1 MG | $1,570.765 | J-code | — |
| J9072 | Inj cyclophos avyxa 5mg | 5 MG | $9.053 | J-code | — |
| J9296 | Inj pemetrexed (accord) 10mg | 10 mg | $9.736 | J-code | — |
| J9323 | Inj pemetrexed ditromethamin | 10 mg | $10.343 | J-code | — |
| Q4123 | Alloskin | 1 SQ CM | $71.550 | Q-code | — |
| Q4143 | Repriza, 1cm | 1 SQ CM | $33.920 | Q-code | — |
| Q4161 | Bio-connekt per square cm | 1 SQ CM | $1,853.655 | Q-code | — |
| Q4164 | Helicoll, per square cm | 1 SQ CM | $322.151 | Q-code | — |
| Q4170 | Cygnus, per sq cm | 1 SQ CM | $444.740 | Q-code | — |
| Q4173 | Palingen or palingen xplus | 1 SQ CM | $360.508 | Q-code | — |
| Q4180 | Revita, per sq cm | 1 SQ CM | $1,030.144 | Q-code | — |
| Q4193 | Coll-e-derm 1 sq cm | 1 SQ CM | $1,608.269 | Q-code | — |
| Q4204 | Xwrap 1 sq cm | 1 SQ CM | $2,929.017 | Q-code | — |
| Q4221 | Amniowrap2 per sq cm | 1 SQ CM | $2,014.000 | Q-code | — |
| Q4227 | Amniocore per sq cm | 1 SQ CM | $1,192.500 | Q-code | — |
| Q4239 | Amnio-maxx or lite per sq cm | 1 SQ CM | $2,349.924 | Q-code | — |
| Q4248 | Dermacyte amn mem allo sq cm | 1 SQ CM | $2,797.108 | Q-code | — |
| Q4250 | Amnioamp-mp per sq cm | 1 SQ CM | $2,863.134 | Q-code | — |
| Q4263 | Surgraft tl, per sq cm | 1 SQ CM | $1,712.999 | Q-code | — |
| Q4264 | Cocoon membrane, per sq cm | 1 SQ CM | $478.060 | Q-code | — |
| Q4269 | Surgraft xt per sq cm | 1 SQ CM | $2,862.000 | Q-code | — |
| Q4270 | Complete sl per sq cm | 1 SQ CM | $3,370.800 | Q-code | — |
| Q4274 | Esano ac, per sq cm | 1 SQ CM | $1,838.291 | Q-code | — |
| Q4275 | Esano aca, per sq cm | 1 SQ CM | $2,676.500 | Q-code | — |
| Q4290 | Membrane wrap hydr per sq cm | 1 SQ CM | $1,841.001 | Q-code | — |
| Q4293 | Acesso dl, per sq cm | 1 SQ CM | $1,584.700 | Q-code | — |
| Q4294 | Amnio quad-core, per sq cm | 1 SQ CM | $2,650.000 | Q-code | — |
| Q4295 | Amnio tri-core, per sq cm | 1 SQ CM | $2,332.000 | Q-code | — |
| Q4296 | Rebound matrix, per sq cm | 1 SQ CM | $1,476.130 | Q-code | — |
| Q4299 | Amnicore pro+, per sq cm | 1 SQ CM | $2,597.000 | Q-code | — |
| Q4309 | Via matrix, per sq cm | 1 SQ CM | $1,323.965 | Q-code | — |
| Q4313 | Dermabind fm, per sq cm | 1 SQ CM | $3,337.231 | Q-code | — |
| Q4319 | Sanograft, per sq cm | 1 SQ CM | $2,650.000 | Q-code | — |
| Q4322 | Caregraft, per sq cm | 1 SQ CM | $1,855.000 | Q-code | — |
| Q4323 | Alloply, per sq cm | 1 SQ CM | $1,643.000 | Q-code | — |
| Q4325 | Acapatch, per sq cm | 1 SQ CM | $2,067.000 | Q-code | — |
| Q4328 | Most, per sq cm | 1 SQ CM | $3,710.000 | Q-code | — |
| Q4332 | Axolotl dualgraft, per sq cm | 1 SQ CM | $1,696.165 | Q-code | — |
| Q4343 | Dermacyte ac matrx per sq cm | 1 SQ CM | $2,952.100 | Q-code | — |
| Q5147 | Inj, aflibercept-ayyh, 1 mg | 1 MG | $795.861 | biosimilar (Q5) | — |
Retired in Q2 2025
| Code | Descriptor (last quarter listed) | Billing unit | Bill instead |
|---|---|---|---|
| J0630 | Calcitonin salmon injection | 400 UNITS | — |
| J1300 | Eculizumab injection | 10 MG | — |
| J1940 | Furosemide injection | 20 MG | — |
| J3357 | Ustekinumab sub cu inj, 1 mg | 1 MG | — |
| J9218 | Leuprolide acetate injection | 1 MG | — |
| Q3027 | Inj beta interferon im 1 mcg | 1 MCG | — |
Largest payment-limit moves among covered drugs, Q2 2025
| Code | Descriptor | Q1 2025 | Q2 2025 | Change |
|---|---|---|---|---|
| J9263 | Oxaliplatin | $0.075 | $0.049 | -34.7% |
| J9305 | Inj. pemetrexed nos 10mg | $5.272 | $3.771 | -28.5% |
| J1652 | Fondaparinux sodium | $0.672 | $0.855 | +27.2% |
| J2778 | Ranibizumab injection | $123.979 | $90.414 | -27.1% |
| J2354 | Octreotide inj, non-depot | $0.805 | $0.590 | -26.7% |
| J9045 | Carboplatin injection | $3.630 | $2.930 | -19.3% |
| J9206 | Irinotecan injection | $1.974 | $1.640 | -16.9% |
| J9267 | Paclitaxel injection | $0.109 | $0.126 | +15.6% |
| Q5128 | Inj, cimerli, 0.1 mg | $168.744 | $146.761 | -13.0% |
| Q0138 | Ferumoxytol, non-esrd | $0.377 | $0.328 | -13.0% |
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The Quarterly Rate Reset carries exactly this diff — every new and retired code with its descriptor and payment limit, plus the largest moves — the day the new quarter's file is loaded. No filler between quarters.
Frequently asked
- A drug I bill just got a new J-code. When do I switch?
- On the effective date of the quarter the code appears in (the first day of that quarter). Claims for dates of service before it keep the old code, usually the unclassified J3490/J3590/C9399 with the NDC. Most payers reject the new code on earlier dates and the old code on later ones.
- What is a Q5 code?
- A biosimilar. CMS assigns each biosimilar its own Q5xxx code so it can be paid at its own ASP rather than the reference product's. The reference product keeps its J-code. When a biosimilar launches, its Q5 code appears here in the quarter it was added to the file.
- A code disappeared from the file. Is the drug no longer covered?
- Not necessarily. A code is retired when the product is discontinued, when CMS consolidates it into another code, or when the manufacturer stops reporting ASP and the drug moves to a different pricing method. Check the retired table for the last descriptor, then the drug page for its current code.
- Where does this list come from?
- From the quarterly Medicare Part B payment-limit file published by CMS, loaded into this site's data each quarter. The diff between consecutive quarters is computed at build time; nothing on this page is typed by hand.
Related references
Price the new code at your payer
CareCost carries every code in the current file with its payment limit and your payer’s published rate, so a code that appeared this quarter prices the day it is loaded.
Run a free estimateSources & how this is maintained
- Source
- CMS Medicare Part B Payment Limit Files, 2025 Q1 through Q4 2026. Loaded per docs/medicare-asp-refresh.md; the ingested quarter is recorded in data/ingested-quarters.json.
- Computed
- Added = in this quarter's file and not the previous; retired = the reverse; moves = payment-limit change on the same code. Ten largest moves shown per quarter.
- What this page does not know
- Why a code was retired, or a code's coverage status. Descriptors are CMS's short descriptors.
- Corrections
- Send one with the code and quarter.