| Payment Allowance Limits for Medicare Part B Drugs | ||||||||||
| Effective April 1, 2006 through June 30, 2006 | ||||||||||
| Note 1: Pa | ||||||||||
| 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. |
||||||||||
| HCPCS Code | Short Description | HCPCS Code Dosage | Payment Limit | Vaccine AWP% | Vaccine Limit | Infusion AWP% | DME Infusion Limit | Blood AWP% | Blood Limit | Notes |
| 90371 | Hep b ig, im | 1 ML | $119.736 | |||||||
| 90375 | Rabies ig, im/sc | 150 IU | $64.591 | |||||||
| 90376 | Rabies ig, heat treated | 150 IU | $69.231 | |||||||
| 90385 | Rh ig, minidose, im | 50 MCG | $4.928 | |||||||
| 90585 | Bcg vaccine, percut | 50 MG | $116.558 | |||||||
| 90586 | Bcg vaccine, intravesical | 1 EACH | $111.537 | |||||||
| 90632 | Hep a vaccine, adult im | 1 ML | $46.827 | |||||||
| 90633 | Hep a vacc, ped/adol, 2 dose | 1 ML | $23.829 | |||||||
| 90634 | Hep a vacc, ped/adol, 3 dose | 3 EACH | $23.855 | |||||||
| 90645 | Hib vaccine, hboc, im | 1 EACH | $21.524 | |||||||
| 90647 | Hib vaccine, prp-omp, im | 0.5 ML | $21.524 | |||||||
| 90648 | Hib vaccine, prp-t, im | 0.5 ML | $21.782 | |||||||
| 90655 | Flu vaccine no preserv 6-35m | 0.25 ML | $14.678 | 95% | $14.678 | |||||
| 90656 | Flu vaccine no preserv 3 & > | 0.50 ML | $15.818 | 95% | $15.818 | |||||
| 90657 | Flu vaccine, 6-35 mo, im | 0.25 ML | $6.028 | 95% | $6.028 | |||||
| 90658 | Flu vaccine age 3 & over, im | 0.5 ML | $12.056 | 95% | $12.056 | |||||
| 90660 | Flu vaccine, nasal | 0.5 ML | $21.176 | 95% | $21.176 | |||||
| 90675 | Rabies vaccine, im | 1 ML | $156.732 | |||||||
| 90691 | Typhoid vaccine, im | 0.5 ML | $50.679 | |||||||
| 90700 | Dtap vaccine, < 7 yrs, im | 0.5 ML | $23.466 | |||||||
| 90702 | Dt vaccine < 7, im | 0.5 ML | $18.300 | |||||||
| 90703 | Tetanus vaccine, im | 0.5 ML | $18.337 | |||||||
| 90704 | Mumps vaccine, sc | 0.5 ML | $19.144 | |||||||
| 90705 | Measles vaccine, sc | 0.5 ML | $14.518 | |||||||
| 90706 | Rubella vaccine, sc | 0.5 ML | $16.161 | |||||||
| 90707 | Mmr vaccine, sc | 0.5 ML | $38.586 | |||||||
| 90713 | Poliovirus, ipv, sc/im | 0.5 ML | $24.888 | |||||||
| 90714 | Td vaccine no prsrv >/= 7 im | 0.5 ML | $18.266 | |||||||
| 90716 | Chicken pox vaccine, sc | 0.5 ML | $67.475 | |||||||
| 90717 | Yellow fever vaccine, sc | 0.5 ML | $54.440 | |||||||
| 90718 | Td vaccine > 7, im | 0.5 ML | $18.266 | |||||||
| 90721 | Dtap/hib vaccine, im | 1 EACH | $41.724 | |||||||
| 90732 | Pneumococcal vaccine | 0.5 ML | $27.028 | 95% | $27.028 | |||||
| 90733 | Meningococcal vaccine, sc | 0.5 ML | $84.460 | |||||||
| 90735 | Encephalitis vaccine, sc | 1 ML | $100.099 | |||||||
| 90740 | Hepb vacc, ill pat 3 dose im | 40 MCG | $113.914 | 95% | $113.914 | |||||
| 90743 | Hep b vacc, adol, 2 dose, im | 10 MCG | $57.551 | 95% | $57.551 | |||||
| 90744 | Hepb vacc ped/adol 3 dose im | 1 DOSE | $68.381 | 95% | $68.381 | |||||
| 90746 | Hep b vaccine, adult, im | 1 EACH | $56.957 | 95% | $56.957 | |||||
| 90747 | Hepb vacc, ill pat 4 dose im | 40 MCG | $113.914 | 95% | $113.914 | |||||
| J0128 | Abarelix injection | 10 MG | $66.833 | |||||||
| J0130 | Abciximab injection | 10 MG | $457.273 | |||||||
| J0132 | Acetylcysteine injection | 100 MG | $1.874 | |||||||
| J0133 | Acyclovir injection | 5 MG | $0.026 | |||||||
| J0135 | Adalimumab injection | 20 MG | $307.302 | |||||||
| J0150 | Injection adenosine 6 MG | 6 MG | $30.189 | |||||||
| J0152 | Adenosine injection | 30 MG | $70.071 | |||||||
| J0170 | Adrenalin epinephrin inject | 1 ML | $0.570 | |||||||
| J0180 | Agalsidase beta injection | 1 MG | $127.200 | |||||||
| J0205 | Alglucerase injection | 10 UNITS | $39.220 | |||||||
| J0207 | Amifostine | 500 MG | $452.684 | |||||||
| J0210 | Methyldopate hcl injection | 250 MG | $9.950 | |||||||
| J0215 | Alefacept | 0.5 MG | $26.153 | revised 7/1/06 | ||||||
| J0256 | Alpha 1 proteinase inhibitor | 10 MG | $3.242 | |||||||
| J0270 | Alprostadil for injection | 1.25 MCG | $1.815 | |||||||
| J0275 | Alprostadil urethral suppos | 125 MCG | $21.995 | |||||||
| J0278 | Amikacin sulfate injection | 100 MG | $1.309 | revised 7/1/06 | ||||||
| J0280 | Aminophyllin 250 MG inj | 250 MG | $0.414 | |||||||
| J0282 | Amiodarone HCl | 30 MG | $0.193 | |||||||
| J0285 | Amphotericin B | 50 MG | $8.879 | 95% | $10.280 | revised 7/1/06 | ||||
| J0287 | Amphotericin b lipid complex | 10 MG | $11.205 | 95% | $21.850 | |||||
| J0288 | Ampho b cholesteryl sulfate | 10 MG | $12.000 | 95% | $15.200 | |||||
| J0289 | Amphotericin b liposome inj | 10 MG | $17.566 | 95% | $35.800 | |||||
| J0290 | Ampicillin 500 MG inj | 500 MG | $1.888 | revised 7/1/06 | ||||||
| J0295 | Ampicillin sodium per 1.5 gm | 1.5 GM | $4.518 | |||||||
| J0300 | Amobarbital 125 MG inj | 125 MG | $2.145 | |||||||
| J0330 | Succinycholine chloride inj | 20 MG | $0.140 | |||||||
| J0350 | Injection anistreplase 30 u | 30 UNITS | $2,265.460 | |||||||
| J0360 | Hydralazine hcl injection | 20 MG | $5.106 | |||||||
| J0365 | Aprotonin, 10,000 kiu | 10000 KIU | $2.347 | |||||||
| J0456 | Azithromycin | 500 MG | $25.324 | |||||||
| J0460 | Atropine sulfate injection | 0.3 MG | $0.227 | |||||||
| J0470 | Dimecaprol injection | 100 MG | $21.834 | |||||||
| J0475 | Baclofen 10 MG injection | 10 MG | $193.322 | 95% | $215.180 | |||||
| J0476 | Baclofen intrathecal trial | 50 MCG | $70.872 | 95% | $79.800 | |||||
| J0480 | Basiliximab | 20 MG | $1,402.038 | |||||||
| J0500 | Dicyclomine injection | 20 MG | $15.112 | |||||||
| J0515 | Inj benztropine mesylate | 1 MG | $4.774 | |||||||
| J0530 | Penicillin g benzathine inj | 600000 UNITS | $13.069 | |||||||
| J0540 | Penicillin g benzathine inj | 1200000 UNITS | $25.889 | |||||||
| J0550 | Penicillin g benzathine inj | 2400000 UNITS | $32.597 | |||||||
| J0560 | Penicillin g benzathine inj | 600000 UNITS | $19.463 | |||||||
| J0570 | Penicillin g benzathine inj | 1200000 UNITS | $33.827 | |||||||
| J0580 | Penicillin g benzathine inj | 2400000 UNITS | $68.507 | |||||||
| J0583 | Bivalirudin | 1 MG | $1.635 | |||||||
| J0585 | Botulinum toxin a per unit | 1 UNIT | $4.901 | |||||||
| J0587 | Botulinum toxin type B | 100 UNITS | $7.929 | |||||||
| J0592 | Buprenorphine hydrochloride | 0.1 MG | $0.747 | |||||||
| J0595 | Butorphanol tartrate 1 mg | 1 MG | $0.839 | |||||||
| J0600 | Edetate calcium disodium inj | 1000 MG | $40.179 | |||||||
| J0610 | Calcium gluconate injection | 10 ML | $0.545 | |||||||
| J0630 | Calcitonin salmon injection | 400 UNITS | $37.810 | |||||||
| J0636 | Inj calcitriol per 0.1 mcg | 0.1 MCG | $0.462 | |||||||
| J0637 | Caspofungin acetate | 5 MG | $32.496 | |||||||
| J0640 | Leucovorin calcium injection | 50 MG | $0.913 | |||||||
| J0670 | Inj mepivacaine HCL/10 ml | 10 ML | $1.363 | revised 7/1/06 | ||||||
| J0690 | Cefazolin sodium injection | 500 MG | $1.287 | revised 7/1/06 | ||||||
| J0692 | Cefepime HCl for injection | 500 MG | $7.818 | |||||||
| J0694 | Cefoxitin sodium injection | 1 GM | $7.516 | |||||||
| J0696 | Ceftriaxone sodium injection | 250 MG | $4.187 | revised 7/1/06 | ||||||
| J0697 | Sterile cefuroxime injection | 750 MG | $1.770 | |||||||
| J0698 | Cefotaxime sodium injection | 1 GM | $4.317 | |||||||
| J0702 | Betamethasone acet&sod phosp | 3 MG | $5.068 | |||||||
| J0704 | Betamethasone sod phosp/4 MG | 4 MG | $0.907 | |||||||
| J0706 | Caffeine citrate injection | 5 MG | $3.369 | |||||||
| J0713 | Inj ceftazidime per 500 mg | 500 MG | $4.073 | |||||||
| J0715 | Ceftizoxime sodium / 500 MG | 500 MG | $3.559 | |||||||
| J0720 | Chloramphenicol sodium injec | 1 GM | $12.039 | |||||||
| J0725 | Chorionic gonadotropin/1000u | 1000 UNITS | $3.132 | |||||||
| J0735 | Clonidine hydrochloride | 1 MG | $63.311 | |||||||
| J0740 | Cidofovir injection | 375 MG | $764.239 | |||||||
| J0743 | Cilastatin sodium injection | 250 MG | $13.205 | |||||||
| J0744 | Ciprofloxacin iv | 200 MG | $8.320 | |||||||
| J0745 | Inj codeine phosphate /30 MG | 30 MG | $0.950 | |||||||
| J0760 | Colchicine injection | 1 MG | $4.543 | |||||||
| J0770 | Colistimethate sodium inj | 150 MG | $25.080 | |||||||
| J0780 | Prochlorperazine injection | 10 MG | $2.284 | |||||||
| J0795 | Corticorelin ovine triflutal | 1 MCG | $4.260 | |||||||
| J0800 | Corticotropin injection | 40 UNITS | $109.884 | |||||||
| J0835 | Inj cosyntropin per 0.25 MG | 0.25 MG | $64.155 | |||||||
| J0850 | Cytomegalovirus imm IV /vial | PER VIAL | $762.988 | |||||||
| J0878 | Daptomycin injection | 1 MG | $0.313 | |||||||
| J0881 | Darbepoetin alfa, non-esrd | 1 MCG | $3.033 | |||||||
| J0882 | Darbepoetin alfa, esrd use | 1 MCG | $3.033 | |||||||
| J0885 | Epoetin alfa, non-esrd | 1000 UNITS | $9.339 | |||||||
| J0886 | Epoetin alfa, esrd | 1000 UNITS | $9.334 | |||||||
| J0895 | Deferoxamine mesylate inj | 500 MG | $14.912 | 95% | $15.630 | |||||
| J0900 | Testosterone enanthate inj | 1 CC | $1.379 | |||||||
| J0945 | Brompheniramine maleate inj | 10 MG | $0.732 | |||||||
| J0970 | Estradiol valerate injection | 40 MG | $32.524 | |||||||
| J1000 | Depo-estradiol cypionate inj | 5 MG | $5.303 | |||||||
| J1020 | Methylprednisolone 20 MG inj | 20 MG | $2.803 | |||||||
| J1030 | Methylprednisolone 40 MG inj | 40 MG | $5.231 | |||||||
| J1040 | Methylprednisolone 80 MG inj | 80 MG | $9.421 | |||||||
| J1051 | Medroxyprogesterone inj | 50 MG | $5.234 | |||||||
| J1056 | MA/EC contraceptiveinjection | 5 MG | $22.885 | |||||||
| J1060 | Testosterone cypionate 1 ML | 1 ML | $4.142 | |||||||
| J1070 | Testosterone cypionat 100 MG | 100 MG | $5.156 | |||||||
| J1080 | Testosterone cypionat 200 MG | 200 MG | $12.517 | |||||||
| J1094 | Inj dexamethasone acetate | 1 MG | $0.230 | |||||||
| J1100 | Dexamethasone sodium phos | 1 MG | $0.127 | |||||||
| J1110 | Inj dihydroergotamine mesylt | 1 MG | $25.271 | |||||||
| J1120 | Acetazolamid sodium injectio | 500 MG | $14.946 | |||||||
| J1160 | Digoxin injection | 0.5 MG | $1.034 | |||||||
| J1162 | Digoxin immune fab (ovine) | PER VIAL | $532.483 | |||||||
| J1165 | Phenytoin sodium injection | 50 MG | $0.844 | |||||||
| J1170 | Hydromorphone injection | 4 MG | $1.765 | 95% | $1.490 | |||||
| J1180 | Dyphylline injection | 500 MG | $8.045 | |||||||
| J1190 | Dexrazoxane HCl injection | 250 MG | $181.330 | |||||||
| J1200 | Diphenhydramine hcl injectio | 50 MG | $0.791 | |||||||
| J1205 | Chlorothiazide sodium inj | 500 MG | $12.815 | |||||||
| J1212 | Dimethyl sulfoxide 50% 50 ML | 50 ML | $42.103 | |||||||
| J1230 | Methadone injection | 10 MG | $3.485 | 95% | $0.750 | |||||
| J1240 | Dimenhydrinate injection | 50 MG | $3.779 | |||||||
| J1245 | Dipyridamole injection | 10 MG | $1.706 | |||||||
| J1250 | Inj dobutamine HCL/250 mg | 250 MG | $4.779 | 95% | $4.740 | |||||
| J1260 | Dolasetron mesylate | 10 MG | $6.824 | |||||||
| J1265 | Dopamine injection | 40 MG | $0.729 | |||||||
| J1270 | Injection, doxercalciferol | 1 MCG | $3.167 | |||||||
| J1320 | Amitriptyline injection | 20 MG | $2.237 | |||||||
| J1325 | Epoprostenol injection | 0.5 MG | $13.200 | 95% | $12.640 | |||||
| J1327 | Eptifibatide injection | 5 MG | $13.440 | |||||||
| J1335 | Ertapenem injection | 500 MG | $23.172 | |||||||
| J1364 | Erythro lactobionate /500 MG | 500 MG | $5.602 | |||||||
| J1380 | Estradiol valerate 10 MG inj | 10 MG | $11.974 | |||||||
| J1390 | Estradiol valerate 20 MG inj | 20 MG | $16.262 | |||||||
| J1410 | Inj estrogen conjugate 25 MG | 25 MG | $58.332 | |||||||
| J1430 | Ethanolamine oleate 100 mg | 100 MG | $72.252 | |||||||
| J1435 | Injection estrone per 1 MG | 1 MG | $0.138 | |||||||
| J1436 | Etidronate disodium inj | 300 MG | $71.407 | |||||||
| J1438 | Etanercept injection | 25 MG | $155.584 | |||||||
| J1440 | Filgrastim 300 mcg injection | 300 MCG | $184.266 | |||||||
| J1441 | Filgrastim 480 mcg injection | 480 MCG | $292.346 | |||||||
| J1450 | Fluconazole | 200 MG | $11.853 | |||||||
| J1451 | Fomepizole, 15 mg | 15 MG | $11.933 | |||||||
| J1452 | Intraocular Fomivirsen na | 1.65 MG | $212.000 | |||||||
| J1455 | Foscarnet sodium injection | 1000 MG | $10.794 | 95% | $13.070 | revised 7/1/06 | ||||
| J1457 | Gallium nitrate injection | 1 MG | $1.247 | |||||||
| J1460 | Gamma globulin 1 CC inj | 1 CC | $10.686 | |||||||
| J1470 | ||||||||||