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HCPCS Codes & Medicare Payment
Payment Allowance Limits for Medicare Part B Drugs
Effective January 1, 2010 - March, 31, 2010
 
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HCPCS Code Description HCPCS Code Dosage Payment Limit
90371 Hep b ig, im 1mL $116.396
90375 Rabies ig, im/sc 150 iu $153.812
90376 Rabies ig, heat treated 150 iu $142.756
90385 Rh ig, minidose, im 50 mcg $25.429
90585 Bcg vaccine, percut 50 mg $110.219
90586 Bcg vaccine, intravesical 1 each $110.637
90632 Hep a vaccine, adult im 1 mL $44.059
90633 Hep a vacc, ped/adol, 2 dose 0.5 mL $21.165
90645 Hib vaccine, hboc, im 1 each $20.367
90647 Hib vaccine, prp-omp, im 0.5 mL $20.367
90648 Hib vaccine, prp-t, im 0.5 mL $22.830
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 $176.577
90691 Typhoid vaccine, im 0.m mL $58.936
90700 Dtap vaccine, <7 yo, im 0.5 mL $15.299
90702 Dt vaccine <7 yo, im 0.5 mL $30.806
90703 Tetanus vaccine, im 0.5 mL $22.513
90704 Mumps vaccine, sc 0.5 mL $22.783
90705 Measles vaccine, sc 0.5 mL $17.427
90706 Rubella vaccine, sc 0.5 mL $19.505
90707 Mmr vaccine, sc 0.5 mL $47.148
90713 Poliovirus, ipv, sc/im 0.5 mL $28.289
90714 Td  vaccine no prsrv >/= 7 yo, im 0.5 mL $20.122
90715 Tdap => 7 yo, im 0.5 mL $33.170
90716 Chicken pox vaccine, sc 0.5 mL $81.750
90717 Yellow fever vaccine, sc 0.5 mL $59.486
90718 Td vaccine >/= 7 yo, im 0.5 mL $20.493
90721 Dtap/hib vaccine, im 1 each $44.880
90732 Pneumococcal vaccine 0.5 mL $37.607
90733 Meningococcal vaccine, sc 0.5 mL $100.430
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 $59.708
A9576 Inj prohance multipack 1 mL $2.298
A9577 Inj multihance 1 mL $2.582
A9578 Inj multihance multipack 1 mL $2.511
A9579 Gad-base MR contrast NOS, 1mL 1 mL $2.248
A9581 Gadoxetate disodium inj 1 mL $13.504
J0129 Abatacept injection 10 mg $19.521
J0130 Abciximab injection 10 mg $463.453
J0132 Acetylcysteine injection 100 mg $2.370
J0133 Acyclovir injection 5 mg $0.030
J0135 Adalimumab injection 20 mg $366.810
J0150 Injection adenosine 6 mg 6 mg $10.203
J0152 Adenosine injection 30 mg $80.924
J0170 Adrenalin epinephrin injection 1 ml $0.854
J0180 Agalsidase beta injection 1 mg $136.254
J0205 Alglucerase injection 10 units $41.987
J0207 Amifostine 500 mg $340.108
J0210 Methyldopate hcl injection 250 mg $33.231
J0215 Alefacept 0.5 mg $30.721
J0220 Alglucosidase alfa injection 10 mg $127.086
J0256 Alpha 1 proteinase inhibitor 10 mg $3.736
J0270 Alprostadil for injection 1.25 mcg $0.697
J0275 Alprostadilfor injection 1.25 mcg $24.531
J0278 Amikacin sulfate injection 100 mg $0.547
J0280 Aminophyllin 250 mg inj 250 mg $0.389
J0282 Amiodarone HCI 30 mg $0.292
J0285 Amphotericin B 50 mg $12.762
J0287 Amphotericin b lipid complex 10 mg $9.652
J0288 Ampho b cholesteryl sulfate 10 mg $14.000
J0289 Amphotericin b liposome inj 10 mg $15.809
J0290 Ampicillin 500 mg inj 500  mg $2.116
J0295 Ampicillin sodium per 1.5 gm 1.5 gm $2.098
J0330 Succinycholine chloride inj 20 mg $0.146
J0348 Anidulafungin injection 1 mg $1.248
J0360 Hydralazine hcl injection 30 mg $5.022
J0364 Apomorphine hydrochloride 1 mg $4.210
J0365 Aprotonin 10, 000 kiu 10000 kiu $2.646
J0400 Aripiprazole injection 0.25 mg $0.332
J0456 Azithromycin 500 mcg $6.977
J0461 Atropine sulfate injection 0.3 mg $0.035
J0470 Dimecaprol injection 100 mg $27.394
J0475 Baclofen 10 mg injection 10 mg $203.255
J0476 Baclofen intrathecal trial 50 mcg $74.401
J0480 Basiliximab 20 mg $1728.910
J0500 Dicyclomine injection 20 mg $15.819
J0515 Inj benztropine mesylate 1 mg $39.265
J0559 Pen G benzathine/procaine inj 2500 units $0.074
J0560 Penicillin g benzathine inj 600000 units $25.538
J0570 Penecillin g benzathine inj 1200000 units $44.594
J0580 Penicillim g benzathine inj 2400000 units $46.069
J0583 Bivalirudin 1 mg $2.456
J0585 injection, onabotulinumtoxinA 1 unit $5.503
J0586 AbobotulinumtoxinA 5 unit $8.081
J0587 Inj, rimabotulinumtoxinB 100 units $10.579
J0592 Buprenorphine hydrochloride 0.1 mg $0.675
J0594 Busulfan injection 1 mg $14.448
J0595 Butorphanol tartrate 1 mg 1 mg $1.006
J0600 Edetate calcium disodium inj 1000 mg $80.376
J0610 Calcium gluconate injection 10 ml $0.309
J0630 Calcitonin salmon injection 400 units $49.269
J0636 Inj calcitrol per 0.1 mcg 0.1 mcg $0.386
J0637 Casofungin acetate 5 mg $11.762
J0640 Leucovorin calcium injection 50 mg $1.007
J0641 Levoleucovorin injection 0.5 mg $1.361
J0670 Inj mepivacaine HCL 10 mL $1.717
J0690 Cefazolin sodium injection 500 mg $0.604
J0692 Cefepime HCI for injection 500 mg $3.636
J0694 Cefoxitin sodium injection 1 gm $6.111
J0696 Ceftriaxone sodium injection 250 mg $1.123
J0697 Sterile cefurxime injection 750 mg $2.815
J0698 Cefotaxime sodium injection 1 gm $6.693
J0702 Betamethasone acet & sod phosp 3 mg $6.561
J0704 Betamethasone sod phosp/4 mg 4 mg $1.133
J0706 Caffeine citrate injection 5 mg $0.596
J0713 Inj ceftazidime per 500 mg 500 mg $2.353
J0718 Certolizumab pegol inj 1 mg $3.723
J0720 Chloramphenicol sodium injection 1 gm $15.346
J0725 Chorionic gonadtropin 1000 units $5.951
J0735 Clonidine hydrochloride 1 mg $112.582
J0740 Cidofovir injection 375 mg $761.228
J0743 Cilastatin sodium injection 250 mg $11.519
J0744 Ciprofloxacin iv 200 mg $1.230
J0745 Inj codeine phosphate / 30 mg 30 mg $1.258
J0760 Colchicine injection 1 mg $6.572
J0770 Colistimethate sodium inj 150 mg $22.789
J0780 Prochlorperazine injection 10 mg $1.628
J0795 Corticorelin ovine triflutal 1 mcg $4.305
J0800 Corticotropin injection 40 units $2440.353
J0833 Cosyntropin injection NOS 0.25 mg $65.421
J0834 Cosyntropin cortrosyn inj 0.25 mg $91.200
J0850 Cytomegalovirus imm IV/vial per vial $878.825
J0878 Daptomycin injection 1 mg $0.428
J0881 Darbepoetin alfa, non -esrd 1 mcg $2.830
J0882 Darbepoetin alfa, esrd use 1 mcg $2.830
J0885 Epoetin alfa,  non-esrd 1000 units $9.537
J0886 Epoetin alfa 1000 units ESRD 1000 units $9.537
J0894 Decitabine injection 1 mg 29.236
J0895 Deferoxamine mesylate inj 500 mg $11.368
J0970 Estradiol valerate injection 40 mg $23.764
J1000 Depo-estradiol cypionate inj 5 mg $6.829
J1020 Methylprednisolone 20 mg inj 20 mg $1.651
J1030 Methylprednisolone 40 mg inj 40 mg $3.759
J1040 Methylprednisolone 80 MG inj 80 mg $7.095
J1051 Medroxyprogesterone inj 50 mg $7.670
J1070 Testosterone cypionat 100 mg $3.300
J1080 Testosterone cypionat 200 mg $5.098
J1094 Inj dexamethasone acetate 1 mg $0.230
J1100 Dexamethasone sodium phos 1 mg $0.091
J1110 Inj dihydroergotamine mesylt 1 mg $22.464
J1120 Acetazolamid sodium injection 500 mg $35.248
J1160 Digoxin injection 0.5 mg $1.214
J1162 Digoxin immune fab (ovine) per vial $476.579
J1165 Phenytoin sodium injection 50 mg $0.712
J1170 Hydromorphone injection 4 mg $1.411
J1190 Dexrazoxane HCI injection 250 mg $374.158
J1200 Diphenhydramine hcl injection 50 mg $0.815
J1205 Chlorothiazide sodium inj 500 mg $310.771
J1212 Dimethyl sulfoxide 50% 50 mL $69.716
J1230 Methadone injection 10 mg $5.665
J1240 Dimenhydrinate injection 50 mg $3.505
J1245 Dipridamole injection 10 mg $0.909
J1250 Inj dobutamine hcl 250 mg $5.721
J1260 Dolasetron mesylate 10 mg $4.302
J1265 Dopamine injection 40 mg $0.487
J1267 Doripenem injection 10 mg $0.546
J1270 Injection, doxercalciferol 1 mcg $3.076
J1300 Eculizumab injection 10 mg $180.977
J1325 Epoprostenol injection 0.5 mg $14.032
J1327 Eptifibatide injection 5 mg 18.853
J1335 Ertapenem injection 500 mg $26.513
J1364 Erythro lactobionate 500 mg $8.462
J1380 Estradiol valerate 10 mg $9.527
J1390 Estradiol valerate 20 mg $19.054
J1410 Inj estrogen conjugate 25 mg $88.722
J1430 Ethanolamine oleate 100 mg $149.969
J1438 Etanercept injection 25 mg $192.035
J1440 Filgrastim 300 mcg $219.713
J1441 Filgrastim 480 mcg $342.725
J1450 Fluconazole 200 mg $6.842
J1451 Fomepizole 15 mg $7.702
J1453 Fosaprepitant injection 1 mg $1.568
J1455 Foscarnet sodium injection 1000 mg $10.100
J1457 Gallium nitrate injection 1 mg $2.004
J1458 Galsulfase injection 1 mg $340.570
J1459 inj IVIG privigen 500 mg $35.135
J1460 Gamma globulin 1 CC $16.152
J1470 Gamma globulin 2 CC $32.305
J1480 Gamma globulin 3 CC $48.448
J1490 Gamma globulin 4 CC $64.610
J1500 Gamma globulin 5 CC $80.762
J1510 Gamma globulin 6 CC $96.950
J1520 Gamma globulin 7 CC $112.996
J1530 Gamma globulin 8 CC $129.219
J1540 Gamma globulin 9 CC $161.524
J1550 Gamma globulin 10 CC $161.524
J1560 Gamma globulin >10 CC $161.524
J1561 Gamunex injection 500 mg $37.622
J1562 Vivaglobulin, inj 100 mg $7.177
J1566 Immune globulin, powder 500 mg $30.479
J1568 Octagam injection 500 mg $37.713
J1569 Gammagard liquid injection 500 mg $38.533
J1570 Ganciclovir sodium injection 500 mg $46.559
J1572 Flebogamma injection 500 mg $37.124
J1573 Hepagam b intravenous , inj 0.5 mL $50.217
J1580 Garamycin gentamicin inj 80 mg $0.867
J1600 Gold sodium thiomaleate inj 50 mg $11.715
J1610 Glucagon hydrochloride 1 mg $84.232
J1626 Granisetron hcl injecction 100 mcg $1.268
J1630 Haloperidol injection 5 mg $1.731
J1631 Haloperidol decanote inj 50 mg $2.675
J1640 Hemin 1 mg $8.135
J1642 inj heparin sodium per 10 u 10 units $0.156
J1644 inj heparin sodium per 1000u 1000 units $0.293
J1645 Dalteparin sodium 2500 iu $11.376
J1650 inj enoxaparin sodium 10 mg $6.468
J1652 Fondaparinux sodium 0.5 mg $6.156
J1655 Tinzaparin sodium injection 1000 iu $2.650
J1670 Tetanus immune globulin 250 units $211.820
J1720 Hydrocortisone sodium succ inj 100 mg $3.068
Ji740 Ibandronate sodium injection 1 mg $141.609
J1742 Ibutilide furmarate injection 1 mg $403.229
J1743 Idursulfase injection 1 mg $455.030
J1745 Infliximab injection 10 mg $58.664
J1750 Inj iron dextran 50 mg $12.932
J1756 Iron sucrose injection 1 mg $0.372
J1790 Droperidol injection 5 mg $1.832
J1800 Propanolol injection 1 mg $3.264
J1815 Insulin injection 5 units $0.444
J1817 Insulin for insulin pump use 50 units $3.431
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 $0.264
J1930 Lanreotide injection 1 mg $27.135
J1931 Laronidase injection 0.1 mg $25.566
J1940 Furosemide injection 20 mg $0.232
J1945 Lepirudin 50 mg $231.267
J1950 Leuprprolide acetate 3.75 mg $492.702
J1953 Levetiracetam injection 10 mg $0.462
J1955 Inj levocarnitine 1 gm $6.238
J1956 Levofloxacin injection 250 mg $5.621
J1980 Hyoscyamine sulfate inj 0.25 mg $11.589
J2001 Lidocaine injection 10 mg $0.020
J2010 Lincomycin  injection 300 mg $31.535
J2060 Lorazepam injection 2 mg $0.753
J2150 Mannitol injection 50 ml $0.910
J21t5 Meperedine hydrochl 100 mg $1.634
J2185 Meropenem 100 mg $3.876
J2210 Methylergonovin maleate injection 0.2 mg $6.088
J2248 Micafungin sodium injection 1 mg $1.128
J2250 Inj midazolam hydrochloride 1 mg $0.114
J2260 Inj milrinone lactate 5 mg $3.866
J2270 Morphine sulphate injection 10 mg $1.833
J2271 Morphine so4 injection 100 mg $1.144
J2275 Morphine sulfate injection 10 mg $2.894
J2278 Ziconotide injection 1 mcg $6.503
J2280 Moxifloxacin injection 100 mg $2.822
J2300 Nalbuphine hydrochloride injection 10 mg $0.922
J2310 Naloxone hydrochloride 1 mg $4.991
J2315 Naltrexone, depot form 1 mg $2.144
J2323 Natulizumab injection 1 mg $8.236
J2325 Nesirritide injection 0.1 mg $37.968
J2353 Octreotide injection, depot 1 mg $108.232
J2354 Octreotide inj, non-depot 25 mcg $1.142
J2355 Oprelvekin injection 5 mg $245.803
J2357 Omalizumab injection 5 mg $19.222
J2360 Orphenadrine injection 60 mg $7.176
J2370 Phenylphrine hcl injection 1 mL $0.822
J2400 Chloroprocaine hcl injection 30 mL $12.279
J2405 Ondansetron hcl injection 1 mg $0.236
J2410 Oxymorphone hcl injection 1 mg $2.259
J2425 Palifermin injection 50 mcg $11.321
J2430 Pamidronate disodium 30 mg $20.362
J2440 Papaverin hcl injection 60 mg $0.622
J2469 Palonosetron hcl 25 mcg $17.509
J2501 Paricalcitol 1 mcg $3.527
J2503 Pegaptanib sodium injection 0.3 mg $1033.617
J2504 Pegademase bovine 25 iu $247.333
J2505 Pegfilgrastim injection 6 mg $2364.701
J2510 Penecillin g procaine injection 600000 units $10.678
J2515 Pentobarbital sodium injection 50 mg $12.238
J2540 Penecillin g potassium injection 600000 units $0.823
J2543 Piperacillin / tazobactam 1.125 gm $5.979
J2545 Pentamidine non-comp unit 300 mg $46.174
J2550 Promethazine hcl injection 50 mg $1.555
J2560 Phenobarbital sodium injection 120 mg $3.173
J2562 Plerixaforinjection 1 mg $268.716
J2590 Oxytocin injection 10 units $0.661
J2597 desmopressin acetate injection 1 mcg $1.595
J2650 Prednisolnone acetate injection 1 mL $0.173
J2675 Progesterone Injection 50 mg $1.565
J2680 Fluphenazine decanoate 25 mg $5.915
J2690 Procainimide hcl injection 1 gm $3.405
J2700  Oxacillin sodium injection 250 mg $2.000
J2710 Neostigmine methylslfte injection 0.5 mg $0.090
J2720 Protamine sulfate 10 mg $0.539
J2724 Protein c concentrate 10 units $12.190
J2730 Pralidoxime chloride injection 1 gm $90.789
J2760 Phentolaine mesylate injection 5 mg $54.950
J2765 Metoclopramide hcl injection 10 mg $0.373
J2770 Quinupristin / dalfopristin 500 mg $147.117
J2778 Ranibizumab injection 0.1 mg $404.644
J2780 Ranitidine hydrochloride injection 25 mg $1.151
J2783 Rasburicase 0.5 mg $172.486
J2785 Regadenoson injection 0.1 mg $50.848
J2788 Rho d immune globulin 50 mcg $35.957
J2790 Rho d immune globulin injection 300 mcg $86.134
J2791 Rhophylac injection 100 iu $5.217
J2792 Rho(D) immune globulin h, sd 100 iu $18.567
J2794 Risperidone, long acting 0,5 mg $5.036
J2795 Ropivacaine hcl injection 1 mg $0.062
J2796 Romiplostim injection 10 mcg $43.597
J2800 Methocarbamol injection 10 mL $26.394
J2805 Sincalide injection 5 mcg $67.656
J2810 Theophylline injection 40 mg $0.025
J2820 Sargramostin injection 50 mcg $24.265
J2850 Secretin synthetic human injection 1 mcg $20.313
J2916 Na ferric gluconate complex 12.5 mg $4.696
J2920 Methylprednisolone injection 40 mg $2.609
J2930 Methyprednisolone injection 125 mg $3.326
J2993 Reteplase injection 18.1 mg $1282.928
J2297 Alteplase recombinant 1 mg $36.930
J3000 Streptomycin injection 1 gm $7.635
J3010 Fentanyl citrate injection 9.1 mg $9.337
J3030 Sumatriptan succinate 6 mg $43.545
J3070 Pentazocaine injection 30 mg $80.75
J3101 Tenecteplase injection 1 mg $42.648
J3105 Terbutaline sulfate injection 1 mg $2.093
J3120 Testosterone enethate injection 100 mg $3.462
J3130 Testosterone enethate injection 200 mg $7.058
J3230 Chlorpromazine hcl injection 50 mg $8.281
J3240 Thyrotropin injection 0.9 mg $1063.874
J3243 Tigecycline injection 1 mg $1.167
J3246 Tirofiban hcl ),25 mg $7.887
J3250 Trimethobenzamide hcl inj 200 mg $4.837
J3260 Tobramycin sulfate injection 80 mg $1.830
J3285 Treprostinil injection 1 mg $55.887
J3300 triamcinalone A inj PRS free 1 mg $3.224
J3301 Triamcinalone acet injection NOS 10 mg $1.593
J3302 Triamcinalocne diacetate injection 5 mg $0.280
J3303 Triamcinalone hexacetonl injection 5 mg $1.479
J3315 Triptorelin pamoate 3.75 mg $156.375
j3355 Urofollitropin 75 iu $58.536
J3360 Diazepam injection 5 mg $1.022
J3364 Urokinase 5000 iu $9.155
J3365 Urokinase 250000 iu $457.729
J3370 Vancomycin hcl injection 500 mg $3.233
J3396 Verteporfin injection 0.1 mg $9.488
J3410 Hydroxyzine hcl injection 25 mg $1.425
J3411 Thiamine hcl 100 mg $2.495
J3415 Pyridoxine hcl 100 mg $4.956
J3420 Vitamin b 12 injection 1000 mcg $0.268
J3430 Vitamin k phytonadione injection 1 mg $1.518
J3465 Voriconazole injection 10 mg $5.664
J3470 Hyaluronidase ijection 150 units $14.642
J3471 Ovine, up to 999 USP units 1 usp init $0.148
J3472 Ovine, 1000 usp units 1000 usp units $132.915
J3473 Hyaluronidase recombinant 1 usp unit $0.596
J3475 Magnesium sulfate injection 500 mg $0.046
J3480 Potassium chloride injection 2 meq $0.015
J3485 Zidovudine 10 mg $1.308
J3486 Ziprasidone mesylate 10 mg $5.911
J3487 Zoledronic acid 1 mg $219.394
J3488 Reclast injection 1 mg $222.687
J7030 Normal saline solution infusion 1000 cc $0.461
J7040 Normal saline solution infusion 500 mL $0.556
J7042 5% dextrose / normal saline 500 mL $0.335
J7050 Normal saline solution infusion 250 cc $0.278
J7060 5% dextrose / water 500 mL $1.131
J7070 D5W infusion 1000 cc $2.261
J7100 Dextran 40 infusion 500 mL $19.873
J7110 Dextran 75 infusion 500 mL $12.720
J7120 Ringers lactate infusion 1000 cc $1.027
J7185 Xyntaha injection 1 iu $1.085
J7186 Antihemphilic VII / vWF per factor VII iu $0.912
J7187 Humate-P, injection 1 iu $0.877
J7189 Factor VIIa 1 mcg $1.326
J7190 Factor VIII 1 iu $0.866
J7192 Factor VIII recombinant NOS 1 iu $1.096
J7193 Factot IX non-recombinant 1 iu $0.888
J7194 Factor IX complex 1 iu $0.869
J7195 Factor IX recombinant 1 iu $1.109
J7197 Antithrombin III injection 1 iu $2.321
J7198 Anti-inhibitor 1 iu $1.551
J7308 Aminolevulinic acid hcl top 354 mg $129.521
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 $92.283
J7323 Euflexxa injection per dose $114.029
J7324 Orthovisc injection per dose $176.055
J7325 Synvisc or Synvisc-One 1 mg $11.739
J7330 Cultured chondrocytes implant 1 ea $25099.560
J7500 Azathioprine oral 50  mg $0.174
J7501 Azathioprine parenteral 100 mg $95.644
J7502 Cyclosporine oral 100 mg $3.180
J7504 Lymphocyte immune globulin 250 mg $465.251
J7505 Monoclonal antibodies 5 mg $1132.928
J7506 Prednisone oral 5 mg $0.047
J7507 tacrolimus oral 1 mg $3.638
J7509 Methylprednisolone oral 4 mg $0.076
J7510 Prednisolone oral 5 mg $0.023
J7511 Antithymocyte globulin rabbit 25 mg $409.658
J7513 Daclizumab, parenteral 25 mg $388.511
J7515 Cyclosporine oral 25 mg $0.828
J7516 Cyclosporin parenteral 250 mg $23.819
J7517 Mycophenolate mofetil oral 250 mg $2.600
J7518 Mycophenolic acid 180 mg $2.967
J7520 Sirolimus, oral 1 mg $9.653
J7525 Tacrolimus injection 5 mg $139.644
J7605 Arformoterol non-comp unit 15 mcg $5.002
J7606 Formoterol fumarate, inh 20 mcg $4.525
J7608 Acetylcysteine non-comp unit 1 gm $1.826
J7611 Albuterol non-comp con 1 mg $0.084
J7612 Levalbuterol non-comp con 0.5 mg $0.213
J7613 ALbuterol non-comp unit 1 mg $0.046
J7614 Levalbuterol non-comp unit 0.5 mg $0.195
J7620 Albuterol ipratrop non-comp 2.5 mg / 0.5 mg $0.229
J7626 Budesonide non-comp unit 0.5 mg $6.430
J7631 Cromolyn sodium noncomp unit 10 mg $0.472
J7639 Dornase alfa non-comp unit 1 mg $23.869
J7644 Ipratropium bromide non-comp 1 mg $0.211
J7669 Metaproterenol non-comp unit 10 mg $0.252
J7674 Methacholine chloride, neb 1 mg $0.466
J7682 Tobramycin non-comp unit 300 mg $69.214
J8501 Oral aprepitant 5 mg $5.527
J8510 Oral busulfan 2 mg $3.314
J8515 Cabergoline, oral 0.25 mg $3.789
J8520 Cepecitabine, oral 150 mg $6.224
J8521 Capacitabine, oral 500 mg $20.429
J8530 Cyclophosphamide oral 25 mg $0.831
J8540 Oral dexamethasone 0.25 mg $0.414
J8560 Etoposide oral 50 mg $30.265
J8600 Melphalan oral 2 mg $4.783
J8610 Methotrexate oral 2.5 mg $0.134
J8700 Temozolomide 5 mg $8.799
J8705 Topotecan oral 0.25 mg $73.005
J9000 Doxorubicin hcl injection 10 mg $3.475
J9001 Doxorubicin hcl liposome 10 mg $471.379
J9010 ALemtuzumab injection 10 mg $566.186
J9015 Aldesleukin injection 1 ea $846.908
J9017 Arsenic trioxide injection 1 mg $37.542
J9020 Asparaginase injection 10000 units $60.409
J9025 Azacitidine injection 1 mg $4.886
J9027 Clofarabine injection 1 mg $115.537
J9031 Bcg live intavesical vac 1 ea $110.637
J9033 Bendamustine injection 1 mg $18.506
J9035 Bevacizumab injection 10 mg $57.456
J9040 Bleomycin sulfate injection 15 units $28.456
J9041 Bortezomib injection 0.1 mg $38.246
J9045 Carboplatin injection 50 mg $4.837
J9050 Carmustine injection 100 mg $176.872
J9055 Cetuximab injection 10 mg $49.731
J9060 Cisplatin 10 mg injection 10 mg $2.082
J9062 Cisplatin 50 mg injection 50 mg $10.408
J9065 Cladribine 1 mg $23.972
J9070 Cyclophosphamine 100 mg $4.339
J9080 Cyclophosphamide 200 mg $8.678
J9090 Cyclophosphamide 500 mg $21.695
J9091 Cyclophosphamide 1 gm $43.389
J9092 Cyclophospamide 2 gm $86.778
J9093 Cyclophosphamide 100 mg $2.226
J9094 Cyclophosphamide 200 mg $4.452
J9095 Cyclophosphamide 500 mg $11.130
J9096 Cyclophosphamide 1 gm $22.260
J9097 Cyclophosphamide 2 gm $44.520
J9098 CYtarabine liposome injection 10 mg $489.398
J9100 Cytarabine hcl 100 mg $1.796
J9110 Cytarabine hcl 500 mg $3.861
J9130 Dactinomycin injection 0.5 mg $567.036
J9130 Dacarbazine 100 mg $4.135
J9140 Dacarbazine 200 mg $8.107
J9150 Daunorubicin injection 10 mg $16.968
J9151 Daunorubicin citrate injection 10 mg $56.398
J9155 Degarelix injection 1 mg $2.871
J9160 Denileukin diftitox injection 300 mcg $1495.777
J9171 Docetaxel injection 1 mg $17.622
J9175 Elliots b solution 1 mL $4.074
J9178 Epirubicin hcl injection 2 mg $2.647
J9181 Etoposide injection 10 mg $0.446
J9185 Fludarabine phosphate injection 50 mg $161.680
J9190 Fluoroucil injection 500 mg $1.603
J9200 Floxuridine injection 500 mg $43.677
J9201 Gemcitabine hcl injection 200 mg $144.933
J9202 Goserelin acetate implant 3.6 mg $203.869
J9206 Irinotecan injection 20 mg $6.943
J9207 ixabepilone injection 1 mg $63.743
J9208 ifosfomide injection 1 gm $30.079
J9209 Mesna injection 200 mg $4.640
J9211 Idarubicin hcl injection 5 mg $102.833
J9212 Interferon alfacon-1 injection 1 mcg $4.804
J9214 Interferon alfa-2b injection 1 mil units $15.838
J9216 Interferon gamma 1-b injection 3 mil units $299.685
J9217 Leuprolide acetate suspension 7.5 mg $206.520
J9218 Leuprolide acetate injection 1 mg $4.771
J9219 Leuprolide acetate implant 65 mg $4819.820
J9225 Vantas implant 50 mg $1462.694
J9226 Supprelin LA implant 50 mg $14841.081
J9230 Mechlorethamine hcl injection 10 mg $154.148
J9245 Melphalan hydrochl 50 mg $1549.472
J9250 Methotrexate sodium injection 5 mg $0.246
J9260 Methotrexate sodium injection 50 mg $2.456
J9261 Nelarabine injection 50 mg $103.302
J9263 Oxaliplatin 0.5 mg $7.616
J9264 Paclitaxel protein bound 1 mg $9.376
J9265 Paclitaxel injection 30 mg $9.435
J9266 Pegaspargase injection 1 ea $2747.297
J9268 Pentostatin injection 10 mg $1343.796
J9280 Mitomycin injection 5 mg $17.149
J9290 Mitomycin injectionm 20 mg $68.595
J9291 Mitomycin injection 40 mg $137.191
J9293 Mitoxantrone hydrochl 5 mg $47.773
 
Note 1: Payment allowance limits subject to the ASP methodology are based on 2Q09 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 2009 Click Here