BDI Pharma, LLC. Consign Advantage SecuriFLU.com SecuriVAX.com
 

HCPCS Codes & Medicare Payment
Payment Allowance Limits for Medicare Part B Drugs
Effective July 1, 2010 - September 30,2010
 
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HCPCS Code Description HCPCS Code Dosage Payment Limit
90371 Hep b ig, im 1mL $115.760
90375 Rabies ig, im/sc 150 iu $161.078
90376 Rabies ig, heat treated 150 iu $161.125
90385 Rh ig, minidose, im 50 mcg $24.815
90585 Bcg vaccine, percut 50 mg $110.169
90586 Bcg vaccine, intravesical 1 each $110.312
90632 Hep a vaccine, adult im 1 mL $46.762
90633 Hep a vacc, ped/adol, 2 dose 0.5 mL $21.899
90647 Hib vaccine, prp-omp, im 0.5 mL $22.163
90655 Flu vaccine no preserv 6-35m, im 0.25 mL $15.447
90656 Flu vaccine no preserv 3 yo & >, im 0.5 mL $12.541
90657 Flu vaccine, 6-35 mo, im 0.25 mL $5.684
90658 Flu vaccine age 3 yo & over, im 0.5 mL $11.368
90660 Flu vaccine, nasal 0.2 mL $22.316
90669 Pneumococcal vaccine <5yo 0.5 mL $95.481
90675 Rabies vaccine, im 1 mL $174.651
90691 Typhoid vaccine, im 0.m mL $58.285
90703 Tetanus vaccine, im 0.5 mL $25.152
90714 Td  vaccine no prsrv >/= 7 yo, im 0.5 mL $20.276
90715 Tdap => 7 yo, im 0.5 mL $39.573
90717 Yellow fever vaccine, sc 0.5 mL $64.840
90718 Td vaccine >/= 7 yo, im 0.5 mL $15.346
90732 Pneumococcal vaccine 0.5 mL $43.248
90733 Meningococcal vaccine, sc 0.5 mL $103.412
90735 Encephalitis vaccine, sc 1 mL $102.078
90740 Hepb vacc, ill pat 3 dose im 40 mcg $119.415
90743 Hep b vacc, adol, 2 dose, im 1 dose $24.216
90744 Hepb vacc ped/adol 3 dose im 1 dose $24.216
90746 Hep b vaccine, adult, im 20 mcg $59.708
90747 Hepb vacc, ill pat 4 dose im 40 mcg $119.415
A9576 Inj prohance multipack 1 mL $2.272
A9577 Inj multihance 1 mL $2.542
A9578 Inj multihance multipack 1 mL $2.439
A9579 Gad-base MR contrast NOS, 1mL 1 mL $2.145
A9581 Gadoxetate disodium inj 1 mL $13.504
J0129 Abatacept injection 10 mg $19.828
J0130 Abciximab injection 10 mg $90.292
J0132 Acetylcysteine injection 100 mg $2.488
J0133 Acyclovir injection 5 mg $0.031
J0135 Adalimumab injection 20 mg $374.272
J0150 Injection adenosine 6 mg 6 mg $11.371
J0152 Adenosine injection 30 mg $84.983
J0170 Adrenalin epinephrin injection 1 ml $0.738
J0180 Agalsidase beta injection 1 mg $136.186
J0205 Alglucerase injection 10 units $41.973
J0207 Amifostine 500 mg $340.186
J0210 Methyldopate hcl injection 250 mg $38.325
J0215 Alefacept 0.5 mg $30.651
J0220 Alglucosidase alfa injection 10 mg $127.024
J0256 Alpha 1 proteinase inhibitor 10 mg $3.757
J0270 Alprostadil for injection 1.25 mcg $0.657
J0275 Alprostadilfor injection 1.25 mcg $25.525
J0278 Amikacin sulfate injection 100 mg $0.538
J0280 Aminophyllin 250 mg inj 250 mg $0.393
J0282 Amiodarone HCI 30 mg $0.265
J0285 Amphotericin B 50 mg $13.017
J0287 Amphotericin b lipid complex 10 mg $9.998
J0288 Ampho b cholesteryl sulfate 10 mg $12.000
J0289 Amphotericin b liposome inj 10 mg $15.722
J0290 Ampicillin 500 mg inj 500  mg $2.075
J0295 Ampicillin sodium per 1.5 gm 1.5 gm $2.489
J0330 Succinycholine chloride inj 20 mg $0.120
J0348 Anidulafungin injection 1 mg $1.426
J0360 Hydralazine hcl injection 30 mg $4.579
J0364 Apomorphine hydrochloride 1 mg $4.317
J0365 Aprotonin 10, 000 kiu 10000 kiu $2.646
J0400 Aripiprazole injection 0.25 mg $0.352
J0456 Azithromycin 500 mcg $5.904
J0461 Atropine sulfate injection 0.3 mg $0.019
J0470 Dimecaprol injection 100 mg $27.840
J0475 Baclofen 10 mg injection 10 mg $205.233
J0476 Baclofen intrathecal trial 50 mcg $73.373
J0480 Basiliximab 20 mg $1995.204
J0500 Dicyclomine injection 20 mg $21.136
J0515 Inj benztropine mesylate 1 mg $46.276
J0559 Pen G benzathine/procaine inj 2500 units $0.079
J0560 Penicillin g benzathine inj 600000 units $27.212
J0570 Penecillin g benzathine inj 1200000 units $46.904
J0580 Penicillim g benzathine inj 2400000 units $49.536
J0583 Bivalirudin 1 mg $2.522
J0585 injection, onabotulinumtoxinA 1 unit $5.492
J0586 AbobotulinumtoxinA 5 unit $7.630
J0587 Inj, rimabotulinumtoxinB 100 units $10.579
J0592 Buprenorphine hydrochloride 0.1 mg $0.752
J0594 Busulfan injection 1 mg $16.522
J0595 Butorphanol tartrate 1 mg 1 mg $1.083
J5098 C1 esterase inhibitor inj 10 IU $42.746
J0600 Edetate calcium disodium inj 1000 mg $197.372
J0610 Calcium gluconate injection 10 ml $0.328
J0630 Calcitonin salmon injection 400 units $52.025
J0636 Inj calcitrol per 0.1 mcg 0.1 mcg $0.386
J0637 Casofungin acetate 5 mg $11.931
J0640 Leucovorin calcium injection 50 mg $0.945
J0641 Levoleucovorin injection 0.5 mg $0.646
J0670 Inj mepivacaine HCL 10 mL $2.450
J0690 Cefazolin sodium injection 500 mg $0.608
J0692 Cefepime HCI for injection 500 mg $3.236
J0694 Cefoxitin sodium injection 1 gm $5.918
J0696 Ceftriaxone sodium injection 250 mg $1.033
J0697 Sterile cefurxime injection 750 mg $2.764
J0698 Cefotaxime sodium injection 1 gm $4.559
J0702 Betamethasone acet & sod phosp 3 mg $6.296
J0704 Betamethasone sod phosp/4 mg 4 mg $1.133
J0706 Caffeine citrate injection 5 mg $0.486
J0713 Inj ceftazidime per 500 mg 500 mg $2.219
J0718 Certolizumab pegol inj 1 mg $3.792
J0720 Chloramphenicol sodium injection 1 gm $11.990
J0725 Chorionic gonadtropin 1000 units $8.255
J0735 Clonidine hydrochloride 1 mg $78.630
J0740 Cidofovir injection 375 mg $766.433
J0743 Cilastatin sodium injection 250 mg $11.963
J0744 Ciprofloxacin iv 200 mg $1.285
J0745 Inj codeine phosphate / 30 mg 30 mg $1.098
J0760 Colchicine injection 1 mg $6.572
J0770 Colistimethate sodium inj 150 mg $16.994
J0780 Prochlorperazine injection 10 mg $1.868
J0795 Corticorelin ovine triflutal 1 mcg $5.016
J0800 Corticotropin injection 40 units $2441.673
J0833 Cosyntropin injection NOS 0.25 mg $64.726
J0834 Cosyntropin cortrosyn inj 0.25 mg $88.730
J0850 Cytomegalovirus imm IV/vial per vial $878.825
J0878 Daptomycin injection 1 mg $0.432
J0881 Darbepoetin alfa, non -esrd 1 mcg $2.967
J0882 Darbepoetin alfa, esrd use 1 mcg $2.880
J0885 Epoetin alfa,  non-esrd 1000 units $9.663
J0886 Epoetin alfa 1000 units ESRD 1000 units $9.663
J0894 Decitabine injection 1 mg $30.095
J0895 Deferoxamine mesylate inj 500 mg $10.821
J0970 Estradiol valerate injection 40 mg $20.400
J1000 Depo-estradiol cypionate inj 5 mg $6.829
J1020 Methylprednisolone 20 mg inj 20 mg $1.438
J1030 Methylprednisolone 40 mg inj 40 mg $.350
J1040 Methylprednisolone 80 MG inj 80 mg $6.383
J1051 Medroxyprogesterone inj 50 mg $8.795
J1070 Testosterone cypionat 100 mg $3.635
J1080 Testosterone cypionat 200 mg $4.457
J1094 Inj dexamethasone acetate 1 mg $0.230
J1100 Dexamethasone sodium phos 1 mg $0.088
J1110 Inj dihydroergotamine mesylt 1 mg $21.285
J1120 Acetazolamid sodium injection 500 mg $27.823
J1160 Digoxin injection 0.5 mg $1.113
J1162 Digoxin immune fab (ovine) per vial $513.137
J1165 Phenytoin sodium injection 50 mg $0.673
J1170 Hydromorphone injection 4 mg $1.742
J1190 Dexrazoxane HCI injection 250 mg $255.166
J1200 Diphenhydramine hcl injection 50 mg $0.789
J1205 Chlorothiazide sodium inj 500 mg $374.148
J1212 Dimethyl sulfoxide 50% 50 mL $70.554
J1230 Methadone injection 10 mg $6.243
J1240 Dimenhydrinate injection 50 mg $3.408
J1245 Dipridamole injection 10 mg $0.901
J1250 Inj dobutamine hcl 250 mg $5.720
J1260 Dolasetron mesylate 10 mg $4.300
J1265 Dopamine injection 40 mg $0.525
J1267 Doripenem injection 10 mg $0.554
J1270 Injection, doxercalciferol 1 mcg $2.926
J1300 Eculizumab injection 10 mg $185.500
J1325 Epoprostenol injection 0.5 mg $13.574
J1327 Eptifibatide injection 5 mg $19.749
J1335 Ertapenem injection 500 mg $27.561
J1364 Erythro lactobionate 500 mg $8.518
J1380 Estradiol valerate 10 mg $8.501
J1390 Estradiol valerate 20 mg $17.002
J1410 Inj estrogen conjugate 25 mg $93.100
J1430 Ethanolamine oleate 100 mg $149.969
J1438 Etanercept injection 25 mg $194.137
J1440 Filgrastim 300 mcg $230.096
J1441 Filgrastim 480 mcg $360.881
J1450 Fluconazole 200 mg $5.817
J1451 Fomepizole 15 mg $7.584
J1453 Fosaprepitant injection 1 mg $1.672
J1455 Foscarnet sodium injection 1000 mg $10.333
J1457 Gallium nitrate injection 1 mg $2.014
J1458 Galsulfase injection 1 mg $337.718
J1459 inj IVIG privigen 500 mg $35.088
J1460 Gamma globulin 1 CC $18.098
J1470 Gamma globulin 2 CC $36.195
J1480 Gamma globulin 3 CC $54.285
J1490 Gamma globulin 4 CC $72.390
J1500 Gamma globulin 5 CC $90.488
J1510 Gamma globulin 6 CC $108.616
J1520 Gamma globulin 7 CC $126.610
J1530 Gamma globulin 8 CC $144.781
J1540 Gamma globulin 9 CC $162.953
J1550 Gamma globulin 10 CC $180.976
J1560 Gamma globulin >10 CC $180.976
J1561 Gamunex injection 500 mg $37.673
J1562 Vivaglobulin, inj 100 mg $7.269
J1566 Immune globulin, powder 500 mg $30.731
J1568 Octagam injection 500 mg $37.501
J1569 Gammagard liquid injection 500 mg $38.459
J1570 Ganciclovir sodium injection 500 mg $52.988
J1571 Hepagam b im injection 0.5mL $50.443
J1572 Flebogamma injection 500 mg $36.683
J1573 Hepagam b intravenous , inj 0.5 mL $50.443
J1580 Garamycin gentamicin inj 80 mg $0.877
J1600 Gold sodium thiomaleate inj 50 mg $14.142
J1610 Glucagon hydrochloride 1 mg $85.363
J1626 Granisetron hcl injecction 100 mcg $1.041
J1630 Haloperidol injection 5 mg $1.412
J1631 Haloperidol decanote inj 50 mg $2.560
J1640 Hemin 1 mg $8.467
J1642 inj heparin sodium per 10 u 10 units $0.161
J1644 inj heparin sodium per 1000u 1000 units $0.335
J1645 Dalteparin sodium 2500 iu $11.820
J1650 inj enoxaparin sodium 10 mg $6.688
J1652 Fondaparinux sodium 0.5 mg $5.968
J1655 Tinzaparin sodium injection 1000 iu $2.800
J1670 Tetanus immune globulin 250 units $228.292
J1720 Hydrocortisone sodium succ inj 100 mg $3.305
J1740 Ibandronate sodium injection 1 mg $144.005
J1742 Ibutilide furmarate injection 1 mg $273.772
J1743 Idursulfase injection 1 mg $455.030
J1745 Infliximab injection 10 mg $58.587
J1750 Inj iron dextran 50 mg $12.527
J1756 Iron sucrose injection 1 mg $0.366
J1790 Droperidol injection 5 mg $1.915
J1785 Injection imiglucerase 1 unit $4.198
J1790 Droperidol injection 5 mg $2.204
J1800 Propanolol injection 1 mg $3.181
J1815 Insulin injection 5 units $0.449
J1817 Insulin for insulin pump use 50 units $2.188
J1835 Itraconazole injection 50 mg $42.281
J1840 Kanamycin sulfate 500 mg $7.685
J1850 Kanamycin sulfate 75 mg $1.153
J1885 Ketorolac tromethamine inj 15 mg $0.289
J1930 Lanreotide injection 1 mg $29.266
J1931 Laronidase injection 0.1 mg $25.555
J1940 Furosemide injection 20 mg $0.247
J1945 Lepirudin 50 mg $234.305
J1950 Leuprprolide acetate 3.75 mg $526.351
J1953 Levetiracetam injection 10 mg $0.528
J1955 Inj levocarnitine 1 gm $5.009
J1956 Levofloxacin injection 250 mg $5.439
J1980 Hyoscyamine sulfate inj 0.25 mg $10.321
J2001 Lidocaine injection 10 mg $0.020
J2010 Lincomycin  injection 300 mg $5.132
J2020 Linezolid injection 200 mg $33.247
J2060 Lorazepam injection 2 mg $0.734
J2150 Mannitol injection 50 ml $0.918
J2175 Meperedine hydrochl 100 mg $1.621
J2185 Meropenem 100 mg $4.109
J2210 Methylergonovin maleate injection 0.2 mg $6.663
J2248 Micafungin sodium injection 1 mg $1.090
J2250 Inj midazolam hydrochloride 1 mg $0.093
J2260 Inj milrinone lactate 5 mg $3.345
J2270 Morphine sulphate injection 10 mg $2.093
J2271 Morphine so4 injection 100 mg $0.999
J2275 Morphine sulfate injection 10 mg $2.303
J2278 Ziconotide injection 1 mcg $6.583
J2280 Moxifloxacin injection 100 mg $3.008
J2300 Nalbuphine hydrochloride injection 10 mg $0.922
J2310 Naloxone hydrochloride 1 mg $5.771
J2315 Naltrexone, depot form 1 mg $2.411
J2323 Natulizumab injection 1 mg $8.829
J2325 Nesirritide injection 0.1 mg $40.142
J2353 Octreotide injection, depot 1 mg $111.219
J2354 Octreotide inj, non-depot 25 mcg $1.004
J2355 Oprelvekin injection 5 mg $244.690
J2357 Omalizumab injection 5 mg $19.802
J2360 Orphenadrine injection 60 mg $6.573
J2370 Phenylphrine hcl injection 1 mL $0.694
J2400 Chloroprocaine hcl injection 30 mL $12.567
J2405 Ondansetron hcl injection 1 mg $0.171
J2410 Oxymorphone hcl injection 1 mg $2.292
J2425 Palifermin injection 50 mcg $11.384
J2430 Pamidronate disodium 30 mg $14.709
J2440 Papaverin hcl injection 60 mg $0.692
J2469 Palonosetron hcl 25 mcg $18.946
J2501 Paricalcitol 1 mcg $3.509
J2503 Pegaptanib sodium injection 0.3 mg $1024.617
J2504 Pegademase bovine 25 iu $247.333
J2505 Pegfilgrastim injection 6 mg $2470.743
J2510 Penecillin g procaine injection 600000 units $11.495
J2515 Pentobarbital sodium injection 50 mg $12.577
J2540 Penecillin g potassium injection 600000 units $0.653
J2543 Piperacillin / tazobactam 1.125 gm $5.673
J2545 Pentamidine non-comp unit 300 mg $47.562
J2550 Promethazine hcl injection 50 mg $1.480
J2560 Phenobarbital sodium injection 120 mg $3.282
J2562 Plerixaforinjection 1 mg $267.862
J2590 Oxytocin injection 10 units $0.551
J2597 desmopressin acetate injection 1 mcg $1.114
J2650 Prednisolnone acetate injection 1 mL $0.173
J2675 Progesterone Injection 50 mg $1.458
J2680 Fluphenazine decanoate 25 mg $6.322
J2690 Procainimide hcl injection 1 gm $5.899
J2700  Oxacillin sodium injection 250 mg $2.111
J2710 Neostigmine methylslfte injection 0.5 mg $0.093
J2720 Protamine sulfate 10 mg $0.484
J2724 Protein c concentrate 10 units $12.345
J2730 Pralidoxime chloride injection 1 gm $89.273
J2760 Phentolaine mesylate injection 5 mg $54.166
J2765 Metoclopramide hcl injection 10 mg $0.325
J2770 Quinupristin / dalfopristin 500 mg $155.630
J2778 Ranibizumab injection 0.1 mg $405.066
J2780 Ranitidine hydrochloride injection 25 mg $0.896
J2783 Rasburicase 0.5 mg $175.713
J2785 Regadenoson injection 0.1 mg $51.272
J2788 Rho d immune globulin 50 mcg $27.416
J2790 Rho d immune globulin injection 300 mcg $86.993
J2791 Rhophylac injection 100 iu $5.174
J2792 Rho(D) immune globulin h, sd 100 iu $19.950
J2794 Risperidone, long acting 0,5 mg $5.055
J2795 Ropivacaine hcl injection 1 mg $0.059
J2796 Romiplostim injection 10 mcg $44.241
J2800 Methocarbamol injection 10 mL $27.549
J2805 Sincalide injection 5 mcg $72.754
J2810 Theophylline injection 40 mg $0.024
J2820 Sargramostin injection 50 mcg $25.553
J2850 Secretin synthetic human injection 1 mcg $20.313
J2916 Na ferric gluconate complex 12.5 mg $6.609
J2920 Methylprednisolone injection 40 mg $1.917
J2930 Methyprednisolone injection 125 mg $2.598
J2993 Reteplase injection 18.1 mg $1365.751
J2297 Alteplase recombinant 1 mg $38.872
J3000 Streptomycin injection 1 gm $7.306
J3010 Fentanyl citrate injection 0.1 mg $0.339
J3030 Sumatriptan succinate 6 mg $47.923
J3070 Pentazocine injection 30 mg $9.027
J3101 Tenecteplase injection 1 mg $46.991
J3105 Terbutaline sulfate injection 1 mg $1.905
J3120 Testosterone enethate injection 100 mg $3.480
J3130 Testosterone enethate injection 200 mg $5.821
J3230 Chlorpromazine hcl injection 50 mg $8.767
J3240 Thyrotropin injection 0.9 mg $1053.619
J3243 Tigecycline injection 1 mg $1.225
J3246 Tirofiban hcl ),25 mg $7.877
J3250 Trimethobenzamide hcl inj 200 mg $4.660
J3260 Tobramycin sulfate injection 80 mg $2.199
J3285 Treprostinil injection 1 mg $55.887
J3300 triamcinalone A inj PRS free 1 mg $3.217
J3301 Triamcinalone acet injection NOS 10 mg $1.552
J3302 Triamcinalocne diacetate injection 5 mg $0.280
J3303 Triamcinalone hexacetonl injection 5 mg $1.336
J3315 Triptorelin pamoate 3.75 mg $164.585
j3355 Urofollitropin 75 iu $60.905
J3360 Diazepam injection 5 mg $1.073
J3364 Urokinase 5000 iu $9.155
J3365 Urokinase 250000 iu $457.729
J3370 Vancomycin hcl injection 500 mg $3.227
J3396 Verteporfin injection 0.1 mg $9.489
J3410 Hydroxyzine hcl injection 25 mg $1.332
J3411 Thiamine hcl 100 mg $2.552
J3415 Pyridoxine hcl 100 mg $5.251
J3420 Vitamin b 12 injection 1000 mcg $0.298
J3430 Vitamin k phytonadione injection 1 mg $1.829
J3465 Voriconazole injection 10 mg $5.898
J3470 Hyaluronidase ijection 150 units $21.200
J3471 Ovine, up to 999 USP units 1 usp init $0.159
J3472 Ovine, 1000 usp units 1000 usp units $137.800
J3473 Hyaluronidase recombinant 1 usp unit $0.617
J3475 Magnesium sulfate injection 500 mg $0.050
J3480 Potassium chloride injection 2 meq $0.015
J3485 Zidovudine 10 mg $1.332
J3486 Ziprasidone mesylate 10 mg $6.415
J3487 Zoledronic acid 1 mg $221.516
J3488 Reclast injection 1 mg $222.929
J7030 Normal saline solution infusion 1000 cc $0.470
J7040 Normal saline solution infusion 500 mL $0.561
J7042 5% dextrose / normal saline 500 mL $0.328
J7050 Normal saline solution infusion 250 cc $0.281
J7060 5% dextrose / water 500 mL $1.111
J7070 D5W infusion 1000 cc $2.222
J7100 Dextran 40 infusion 500 mL $20.257
J7110 Dextran 75 infusion 500 mL $12.720
J7120 Ringers lactate infusion 1000 cc $1.041
J7185 Xyntaha injection 1 iu $1.034
J7186 Antihemphilic VII / vWF per factor VII iu $0.912
J7187 Humate-P, injection 1 iu $0.868
J7189 Factor VIIa 1 mcg $1.371
J7190 Factor VIII 1 iu $0.877
J7192 Factor VIII recombinant NOS 1 iu $1.097
J7193 Factot IX non-recombinant 1 iu $0.900
J7194 Factor IX complex 1 iu $0.848
J7195 Factor IX recombinant 1 iu $1.106
J7197 Antithrombin III injection 1 iu $2.555
J7198 Anti-inhibitor 1 iu $1.590
J7308 Aminolevulinic acid hcl top 354 mg $136.422
J7310 Ganciclovir long act implant 4.5 mg $16960.000
J7311 Fluocinolone acetonide implant 0.59 mg $19345.000
J7321 Hyalagan/supartz injection per dose $89.352
J7323 Euflexxa injection per dose $117.303
J7324 Orthovisc injection per dose $174.476
J7325 Synvisc or Synvisc-One 1 mg $11.762
J7330 Cultured chondrocytes implant 1 ea $25995.981
J7500 Azathioprine oral 50  mg $0.121
J7501 Azathioprine parenteral 100 mg $97.149
J7502 Cyclosporine oral 100 mg $3.366
J7504 Lymphocyte immune globulin 250 mg $506.786
J7505 Monoclonal antibodies 5 mg $1133.818
J7506 Prednisone oral 5 mg $0.040
J7507 tacrolimus oral 1 mg $3.327
J7509 Methylprednisolone oral 4 mg $0.075
J7510 Prednisolone oral 5 mg $0.023
J7511 Antithymocyte globulin rabbit 25 mg $401.411
J7513 Daclizumab, parenteral 25 mg $526.343
J7515 Cyclosporine oral 25 mg $0.861
J7516 Cyclosporin parenteral 250 mg $24.361
J7517 Mycophenolate mofetil oral 250 mg $1.331
J7518 Mycophenolic acid 180 mg $3.194
J7520 Sirolimus, oral 1 mg $10.066
J7525 Tacrolimus injection 5 mg $139.454
J7605 Arformoterol non-comp unit 15 mcg $5.179
J7606 Formoterol fumarate, inh 20 mcg $4.678
J7608 Acetylcysteine non-comp unit 1 gm $2.008
J7611 Albuterol non-comp con 1 mg $0.090
J7612 Levalbuterol non-comp con 0.5 mg $0.208
J7613 ALbuterol non-comp unit 1 mg $0.069
J7614 Levalbuterol non-comp unit 0.5 mg $0.320
J7620 Albuterol ipratrop non-comp 2.5 mg / 0.5 mg $0.217
J7626 Budesonide non-comp unit 0.5 mg $4.853
J7631 Cromolyn sodium noncomp unit 10 mg $0.447
J7639 Dornase alfa non-comp unit 1 mg $25.511
J7644 Ipratropium bromide non-comp 1 mg $0.221
J7669 Metaproterenol non-comp unit 10 mg $0.252
J7674 Methacholine chloride, neb 1 mg $0.464
J7682 Tobramycin non-comp unit 300 mg $75.154
J8501 Oral aprepitant 5 mg $5.819
J8510 Oral busulfan 2 mg $3.650
J8515 Cabergoline, oral 0.25 mg $3.494
J8520 Cepecitabine, oral 150 mg $6.856
J8521 Capacitabine, oral 500 mg $22.475
J8530 Cyclophosphamide oral 25 mg $0.851
J8540 Oral dexamethasone 0.25 mg $0.367
J8560 Etoposide oral 50 mg $28.330
J8600 Melphalan oral 2 mg $4.818
J8610 Methotrexate oral 2.5 mg $0.128
J8700 Temozolomide 5 mg $9.093
J8705 Topotecan oral 0.25 mg $74.592
J9000 Doxorubicin hcl injection 10 mg $2.940
J9001 Doxorubicin hcl liposome 10 mg $487.987
J9010 ALemtuzumab injection 10 mg $588.454
J9015 Aldesleukin injection 1 ea $843.881
J9017 Arsenic trioxide injection 1 mg $37.371
J9020 Asparaginase injection 10000 units $60.961
J9025 Azacitidine injection 1 mg $5.005
J9027 Clofarabine injection 1 mg $116.464
J9031 Bcg live intavesical vac 1 ea $110.312
J9033 Bendamustine injection 1 mg $18.553
J9035 Bevacizumab injection 10 mg $58.446
J9040 Bleomycin sulfate injection 15 units $26.473
J9041 Bortezomib injection 0.1 mg $39.285
J9045 Carboplatin injection 50 mg $3.981
J9050 Carmustine injection 100 mg $176.151
J9055 Cetuximab injection 10 mg $49.734
J9060 Cisplatin 10 mg injection 10 mg $1.889
J9062 Cisplatin 50 mg injection 50 mg $9.447
J9065 Cladribine 1 mg $25.334
J9070 Cyclophosphamine 100 mg $5.061
J9080 Cyclophosphamide 200 mg $10.121
J9090 Cyclophosphamide 500 mg $25.303
J9091 Cyclophosphamide 1 gm $50.606
J9092 Cyclophospamide 2 gm $101.213
J9098 CYtarabine liposome injection 10 mg $467.931
J9100 Cytarabine hcl 100 mg $1.491
J9110 Cytarabine hcl 500 mg $3.675
J9130 Dactinomycin injection 0.5 mg $570.916
J9130 Dacarbazine 100 mg $3.724
J9140 Dacarbazine 200 mg $7.353
J9150 Daunorubicin injection 10 mg $31.279
J9151 Daunorubicin citrate injection 10 mg $57.664
J9155 Degarelix injection 1 mg $2.419
J9160 Denileukin diftitox injection 300 mcg $1544.314
J9171 Docetaxel injection 1 mg $18.029
J9175 Elliots b solution 1 mL $4.074
J9178 Epirubicin hcl injection 2 mg $2.091
J9181 Etoposide injection 10 mg $0.408
J9185 Fludarabine phosphate injection 50 mg $115.438
J9190 Fluoroucil injection 500 mg $1.475
J9200 Floxuridine injection 500 mg $43.098
J9201 Gemcitabine hcl injection 200 mg $148.633
J9202 Goserelin acetate implant 3.6 mg $198.073
J9206 Irinotecan injection 20 mg $6.794
J9207 ixabepilone injection 1 mg $63.741
J9208 ifosfomide injection 1 gm $30.346
J9209 Mesna injection 200 mg $4.312
J9211 Idarubicin hcl injection 5 mg $52.618
J9212 Interferon alfacon-1 injection 1 mcg $4.804
J9214 Interferon alfa-2b injection 1 mil units $15.795
J9216 Interferon gamma 1-b injection 3 mil units $430.931
J9217 Leuprolide acetate suspension 7.5 mg $205.438
J9218 Leuprolide acetate injection 1 mg $4.104
J9219 Leuprolide acetate implant 65 mg $4819.820
J9225 Vantas implant 50 mg $1399.868
J9226 Supprelin LA implant 50 mg $14579.908
J9230 Mechlorethamine hcl injection 10 mg $154.423
J9245 Melphalan hydrochl 50 mg $1404.665
J9250 Methotrexate sodium injection 5 mg $0.192
J9260 Methotrexate sodium injection 50 mg $1.919
J9261 Nelarabine injection 50 mg $105.776
J9263 Oxaliplatin 0.5 mg $4.462
J9264 Paclitaxel protein bound 1 mg $9.399
J9265 Paclitaxel injection 30 mg $11.558
J9266 Pegaspargase injection 1 ea $2715.455
J9268 Pentostatin injection 10 mg $1267.533
J9280 Mitomycin injection 5 mg $20.185
J9290 Mitomycin injectionm 20 mg $80.738
J9291 Mitomycin injection 40 mg $161.476
J9293 Mitoxantrone hydrochl 5 mg $40.882
J9300 Gemtuzumabozogamicin inj 5 mg $2687.842
J9303 Panitumumab injection 10 mg $87.243
J9305 Pemetrexed 10 mg $51.687
J9310 Rituximab injection 100 mg $579.210
J9320 Stretozocin injection 1 gm $280.550
J9328 Temozolomide injection 1 mg $4.899
J9330 Temsirolimus injection 1 mg $50.815
J9340 Thiotepa injection 15 mg $113.600
J9350 Topotecan injection 4 mg $1058.739
J9355 Trastuzumab injection 10 mg $66.558
J9357 Valrubicin injection 200 mg $962.594
J9360 Vinblastine sulfate injection 1 mg $1.020
J9370 Vincristine sulfate injection 1 mg $4.531
J9375 Vincristine sulfate injection 2 mg $9.062
J9380 Vincristine sulfate injection 5 mg $22.654
J9390 Vinorelbine tartrate injection 10 mg $10.190
J9395 Fulvestrant injection 25 mg $83.036
J9600 Porfimer sodium injection 75 mg $2987.917
P9041 Albumin (human) 5%, 50mL 50 mL $20.520
P9043 Plasma protein fraction 5%, 50 ml 50 mL $8.242
P9045 ALbumin (human), 5%, 250 mL 250 mL $55.100
P9046 Albumin (human) 25%, 20 mL 20 mL $21.082
P9047 Albumin (human) 25%, 50 mL 50 mL $52.706
P9048 Plasmaprotein fraction 5%, 250 mL 250 mL $41.211
Q0138 Ferumoxytol, non-esrd 1 mg $0.788
Q0139 Ferumoxytol, esrd use 1 mg $0.788
Q0163 Diphenhydramine HCI 50 mg $0.019
Q0164 Prochloreperazine maleate 5 mg $0.044
Q0165 Prochlorperazine maleate 10 mg $0.054
Q0166 Granisetron hcl 1 mg $3.774
Q0167 Dronabinol 2.5 mg $7.086
Q0168 Dronabinol 5 mg $14.080
Q0169 Promethazine HCI 12.5 mg $0.399
Q0170 Promethazine HCI 25 mg $0.028
Q0171 Chlorpromazine HCI 10 mg $0.012
Q0172 Chlorpromazine HCi 25 mg $0.031
Q0173 Trimethobenzamide HCI 250 mg $0.751
Q0175 Perphenazine 4 mg $0.581
Q0176 Perphenazine 8 mg $0.551
Q0177 Hydroxyzine pamoate 25 mg $0.047
Q0178 Hydroxazine pamoate 50 mg $0.058
Q1079 Ondansetron hcl 8 mg $5.964
Q0181 Dolasetron meylate 100 mg $63.177
Q0515 Sermorelin acetate injection 1 mcg $1.800
Q2009 Fosphenytoin injection PE 50  mg $0.438
Q2017 Teniposide 50 mg $324.265
Q2025 Fludarabine phospahte 1 mg $8.177
Q3025 Interferon IM injection beta 1-a 11 mcg $193.909
Q4074 lloprost non-comp up to 20 mcg $65.720
Q4081 Epoetin alfa ESRD 100 unites $0.966
Q4101 Apilgraf skin sub 1 sq cm $34.062
Q4102 Oasis wound matrix skin sub 1 sq cm $4.393
Q4103 Oasis burn matrix skin sub 1 sq cm $4.393
Q4104 Integra BMWD skin sub 1 sq cm $15.949
Q4105 Integra DRT skin sub 1 sq cm $9.313
Q4106 Dermagraft skin sub 1 sq cm $40.090
Q4107 Graftjacket skin sub 1 sq cm $94.719
Q4108 Integra matrix skin sub 1 sq cm $19.174
Q4109 Tissuemed skin sub 1 sg cm $78.944
Q4110 Primatrix skin sub 1 sq cm $34.417
Q4111 Gammagraft skin sub 1 sq cm $7.428
Q4112 Cymetra allograft 1cc $347.139
Q1143 Graftjacket express allograft 1cc $347.139
Q4114 Integra flowable wound matrix 1cc $943.047
Q4115 Alloskin sin sub 1 sq cm $7.305
Q4116 Alloderm skin sub 1 sq cm $32.902
Q9953 Inj Fe-based MR contrast 1 mL $62.052
Q9954 MR contrast 100 mL $10.579
Q9956 Octafluropropane mic 1 mL $42.027
Q9957 Perlutren lip micros 1 mL $63.041
Q9958 HOCM<=149 mg/mL iodine 1mL $0.074
Q9960 HOCM 200 -249 mg/mL iodine 1 mL $0.157
Q9961 HOCM 250-299mg/mL iodine 1 mL $0.150
Q9962 HOCM 300-349mg/mL iodine 1 mL $0.183
Q9963 HOCM 350-399mg/mL iodine 1 mL $0.166
Q9964 HOCM>=400mg/mL iodine 1mL $0.292
Q9965 LOCM 100 - 199 MG/Ml IODINE 1 mL $1.103
Q9966 LOCM 200-299mg.mL iodine 1 mL $0.322
Q9967 LOCM 300-399mg/mL iodine 1 mL $0.171
 
Note 1: Payment allowance limits subject to the ASP methodology are based on !Q10 ASP data.
Note 2: The absence or presence of a HCPCS code and the payment allowance limits in this table does not indicate Medicare coverage of the drug. Similarly, the inclusion of a payment allowance limit within a specific column does not indicate Medicare coverage of the drug in that specific category. These determinations shall be made by the local Medicare contractor processing the claim.
For a more complete listing of Payment Allowance limits for 2010 Click Here