The Quarterly Rate Reset — October 2026 payment limits

The Quarterly Rate Reset

CMS released the October 2026 Part B payment-limit file. Here's what changed: 800 payment limits moved, 38 codes are new, and 10 were retired.

Source: the CMS quarterly ASP pricing file (cms.gov ASP pricing files). Payment limit = ASP + 6%. Codes we cover link straight to their billing reference; the rest link to the full by-code index.

New codes this quarter

Billable as of the file's effective date — the first quarter a code appears is when practices lose money to "not yet in the charge master."

• 90616 — Flu vacc trivalent mRNA IM ($171.21 per )
• J0014 — Cocaine hcl nasal (goprelto) ($1.82 per 1 MG)
• J0528 — Inj fosfomycin disodium 20mg ($0.63 per 20 MG)
• J0643 — Inj leucovorin calcium 1 mg ($0.05 per 1 MG)
• J0644 — Inj, leucovorin cal (avyxa) ($2.63 per 1 MG)
• J0716 — Centruroides immune f(ab) ($5,449.65 per UP TO 120MG)
• J0841 — Inj crotalidae im f(ab')2 eq ($1,084.91 per 120 MG)
• J0871 — Inj, daptomycin (endo) 1mg ($0.54 per 1 MG)
• J1289 — Narsoplimab-wuug, 1 mg ($105.44 per 1 MG)
• J1577 — Inj, qivigy, 100mg ($29.28 per 100 MG)

Retired codes

• J0640 — Leucovorin calcium injection
• J1953 — Levetiracetam injection
• J7514 — Mycophenol (myhibbin) 100 mg
• J7517 — Mycophenolate mofetil oral
• J7519 — Inj. mycophenolate mofetil
• J7528 — Mycophen mofetil for susp
• J9181 — Etoposide injection
• J9190 — Fluorouracil injection
• J9352 — Injection trabectedin 0.1mg
• J9394 — Inj, fulvestrant (fresenius)

Claims using a retired code after its end date will deny. Check your charge master.

Re-quote these first

The limits that moved most among drugs with real dollars attached. Patients scheduled after the effective date owe 20% of the new number, not the old one.

Code	Payment limit	Change
J9304 Inj. pemetrexed, 10 mg	$7.99 → $92.50 per 10 MG	▲ 1057.2%
J3489 Zoledronic acid 1mg	$3.36 → $17.67 per 1 MG	▲ 425.8%
Q5120 Inj pegfilgrastim-bmez 0.5mg	$132.10 → $302.25 per 0.5 MG	▲ 128.8%
Q5119 Inj ruxience, 10 mg	$16.16 → $5.79 per 10 MG	▼ 64.2%
Q5112 Inj ontruzant 10 mg	$20.99 → $32.79 per 10 MG	▲ 56.2%
J2175 Meperidine hydrochl /100 mg	$6.34 → $9.65 per 100 MG	▲ 52.3%
J2562 Plerixafor injection	$28.49 → $42.94 per 1 MG	▲ 50.7%
J2778 Ranibizumab injection	$51.09 → $26.38 per 0.1 mg	▼ 48.4%

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 to try.

— Erin Rose, CareCost
Reply to this email and it reaches me, not a ticket queue.