The Quarterly Rate Reset — April 2026 payment limits
Sent Jul 22, 2026 · 778 payment limits moved · 20 new codes · 11 retired. This is the issue exactly as subscribers received it.
The Quarterly Rate Reset
CMS released the April 2026 Part B payment-limit file. Here's what changed: 778 payment limits moved, 20 codes are new, and 11 were retired.
Source: the CMS quarterly ASP pricing file (cms.gov ASP pricing files). Payment limit = ASP + 6%. Every code below links to its billing reference.
Biggest movers
| Code | Payment limit | Change |
|---|---|---|
| J1240 Dimenhydrinate injection |
$0.92 → $7.72 per 50 MG |
▲ 742.5% |
| J3489 Zoledronic acid 1mg |
$5.08 → $30.88 per 1 MG |
▲ 507.6% |
| J1364 Erythro lactobionate /500 mg |
$20.16 → $91.23 per 500 MG |
▲ 352.5% |
| J7500 Azathioprine oral 50mg |
$0.06 → $0.18 per 50 MG |
▲ 217.5% |
| J8540 Oral dexamethasone |
$0.01 → $0.03 per 0.25 MG |
▲ 200.0% |
| J9185 Fludarabine phosphate inj |
$81.41 → $217.73 per 50 MG |
▲ 167.4% |
| J1456 Inj, fosaprepitant (teva) |
$0.64 → $0.04 per 1 MG |
▼ 94.4% |
| J1072 Inj, testosterone, azmiro |
$1.32 → $0.14 per 1 MG |
▼ 89.8% |
New codes
- J0463 — Inj atropine (fresenius te) ($0.01 per 0.01 MG)
- J0759 — Inj, clevidipine, 1 mg ($2.84 per 1 MG)
- J1164 — Inj diltiazem in 0.72% nacl ($0.18 per 0.5 MG)
- J1553 — Inj yimmugo 100 mg ($24.32 per 100 MG)
- J1612 — Inj glucagon (gvoke) 0.01 mg ($2.37 per 0.01 MG)
- J2545 — Pentamidine non-comp unit ($73.56 per 300 MG)
- J8502 — Inj, aponvie, 1 mg ($1.95 per 1 MG)
- J8515 — Cabergoline, oral 0.25mg ($0.15 per 0.25 MG)
- J9183 — Gemcitabine intravesical sys ($73,088.26 per 225 MG)
- J9184 — Inj gemcitabin (avyxa) 200mg ($410.44 per 200 MG)
Retired codes
- 90586 — Bcg vaccine intravesical
- 90759 — Hep b vac 3ag 10mcg 3 dos im
- J0841 — Inj crotalidae im f(ab')2 eq
- J0893 — Inj, decitabine (sun pharma)
- J2313 — Inj, naloxone (zimhi) 0.01mg
- J3471 — Ovine, up to 999 usp units
- J7674 — Methacholine chloride, neb
- J8670 — Rolapitant, oral, 1mg
- J9202 — Goserelin acetate implant
- J9323 — Inj pemetrexed ditromethamin
Claims using a retired code after its end date will deny. Check your charge master.
Your reload checklist
- Load the new file into your charge master and billing system.
- Re-quote patients scheduled after the effective date — their 20% share moved with the limit.
- Check open prior auths on the new and retired codes above.
Want the new numbers as patient estimates? CareCost re-quotes a patient in about 90 seconds — free during beta.