Medicare ASP Lookup: Payment Limits by J-Code

856 Part B drugs with Q3 2026 CMS payment limits — sourced directly from the CMS quarterly ASP file.

ASP Quarter
J-codes covered856
Page reviewed

About this tool

CMS publishes Medicare Part B drug payment limits as raw quarterly Excel files buried inside a federal download portal — no search, no filtering, no history. Practices calculating drug margins and billing teams verifying reimbursements have to download a spreadsheet, cross-reference J-codes by hand, and repeat every quarter when limits reset. This tool replaces that workflow: search any of the 856 active J-codes by code or drug name and see the current payment limit, the implied ASP per unit, and the last four quarters of history — instantly, in one place.

Search Q3 2026 payment limits

Medicare Part B reimbursement

How Medicare pays for Part B drugs

Medicare Part B covers drugs administered in a physician’s office or hospital outpatient setting — infusions, injections, and chemotherapy regimens that cannot be self-administered. For these drugs, CMS sets the payment limit at 106% of ASP(the “ASP+6%” formula). The 6% add-on is intended to reimburse providers for the cost of acquiring, storing, and administering the drug.

Effective net reimbursement is closer to ASP+4.3%. The 2% federal budget sequester reduces Medicare’s 80% share of the payment (80% × 98% = 78.4%). Add the 20% patient coinsurance and the practice recovers 98.4% of the allowable — which, since the allowable is 106% of ASP, equals roughly 104.3% of ASP. Whether that spread covers acquisition cost depends entirely on the contract price negotiated with the distributor.

Payment limits reset every calendar quarter. CMS collects net transaction price reports from manufacturers covering the prior two quarters, computes a volume-weighted average, and publishes the new ASP file roughly six weeks before the quarter begins. Because the data lags by two quarters, a sharp price change in the market takes about six months to fully appear in the payment limit. Practices operating on thin buy-and-bill margins need to track these quarterly resets, especially for high-cost biologics where a 2–3% ASP shift can flip a drug from profitable to unprofitable to administer.

The payment limits shown in this tool are the CMS-published allowable amounts — the number Medicare pays 80% of, before secondary insurance and patient cost-sharing. They are not the actual contracted rates between payers and providers for the same drugs. For negotiated rates across commercial payers, see the CareCost Explorer rate search.

Frequently Asked Questions

What is the Average Sales Price (ASP) for Medicare Part B drugs?

ASP is the weighted average of all U.S. sales prices for a drug, net of discounts and rebates, reported quarterly by manufacturers to CMS. For drugs administered in a physician's office or hospital outpatient department (Part B), Medicare uses ASP as the baseline to set the payment limit CMS reimburses providers.

How is the Medicare payment limit calculated from ASP?

For most Part B drugs, Medicare pays 106% of ASP — often called ASP+6%. That add-on is meant to cover the cost of acquiring and administering the drug. In practice, after the 2% federal budget sequester reduces Medicare's 80% share, the effective reimbursement is closer to ASP+4.3% of the full allowable (80% × 98% = 78.4%, plus 20% patient coinsurance = 98.4% of the allowable).

Why does the ASP payment limit change every quarter?

CMS resets Part B payment limits each calendar quarter based on fresh manufacturer price reports. If a drug's net transaction prices fall, the ASP drops and so does the Medicare payment limit. Price increases in market terms flow through with a roughly two-quarter lag, since manufacturers report sales data from prior periods. This quarterly cadence means provider margins on Part B drugs can shift materially from one quarter to the next.

What is the difference between ASP, NADAC, and AWP?

ASP (Average Sales Price) is the actual net transaction price across all payers, net of rebates — the most accurate reflection of real-world acquisition cost for Part B drugs. NADAC (National Average Drug Acquisition Cost) serves a similar purpose for retail pharmacy / Medicaid Part D; it is a pharmacy-survey-based acquisition cost, not a manufacturer report. AWP (Average Wholesale Price) is a published list price set by the manufacturer, not an actual transaction price — it is not discounted for rebates and typically runs 20–25% above true market prices. Medicare no longer uses AWP as its primary benchmark for Part B reimbursement.

Medicare is the floor.

See what UnitedHealthcare, Aetna, and BCBS actually pay for the same drugs — 36M+ negotiated rates, normalized.

Explore negotiated rates →