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What changed in Q4 2026

Compared with Q3 2026, using the current CMS release of each quarter (including CMS revisions).
Drug payment limits changed
778
New drug codes
28
Terminated drug codes
13
Crosswalk NDC changes
617

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Largest payment-limit increases

Drug codes whose Part B payment limit per billing unit rose the most from the previous quarter (top 25 by percent).

Largest increases, Q4 2026
HCPCSDescriptionPreviousNowChange
J9304Inj. pemetrexed, 10 mgper 10 MG$7.994$92.505+1057.2%
J3489Zoledronic acid 1mgper 1 MG$3.361$17.673+425.8%
J2516Inj, pentamidine isethionateper 1 MG$0.160$0.482+201.2%
J1920Inj, labetalol hcl, 5mgper 5 MG$0.218$0.588+169.7%
Q9965Locm 100-199mg/ml iodine,1mlper 1 ML$0.750$1.787+138.3%
Q5120Inj pegfilgrastim-bmez 0.5mgper 0.5 MG$132.096$302.247+128.8%
J3379Inj, valproate sod, 5 mgper 5 MG$0.014$0.032+128.6%
J1885Ketorolac tromethamine injper 15 MG$0.286$0.569+99%
J1171Inj, hydromorphone, 0.1 mgper 0.1 MG$0.136$0.224+64.7%
J9263Oxaliplatinper 0.5 MG$0.055$0.087+58.2%
J2151Inj, mannitol, 250 mgper 250 MG$0.071$0.112+57.7%
Q5112Inj ontruzant 10 mgper 10 MG$20.989$32.791+56.2%
J2175Meperidine hydrochl /100 mgper 100 MG$6.339$9.652+52.3%
J2596Vasopressin (long grove) 1 uper 1 UNIT$1.134$1.712+51%
J2562Plerixafor injectionper 1 MG$28.489$42.943+50.7%
J0872Daptomycin (xellia) unrefrigper 1 MG$0.042$0.060+42.9%
J1598Inj glycopyrrolate fres kabiper 0.1 MG$1.342$1.904+41.9%
J0500Dicyclomine injectionper 20 MG$8.520$12.061+41.6%
J2506Inj pegfilgrast ex bio 0.5mgper 0.5 MG$143.233$201.241+40.5%
J0138Inj acetaminoph 10mg/ibu 3mgper 10 MG/3MG$0.092$0.129+40.2%
J7329Inj, trivisc 1 mgper 1 MG$3.036$4.207+38.6%
J0133Acyclovir injectionper 5 MG$0.035$0.048+37.1%
J0456Azithromycinper 500 MG$1.889$2.571+36.1%
J1956Levofloxacin injectionper 250 MG$1.909$2.565+34.4%
J2690Procainamide hcl injectionper 1 GM$295.361$394.868+33.7%

Largest payment-limit decreases

Drug codes whose payment limit fell the most (top 25 by percent). Large drops often follow new competition, such as biosimilar or generic entry.

Largest decreases, Q4 2026
HCPCSDescriptionPreviousNowChange
J9305Inj. pemetrexed nos 10mgper 10 MG$6.952$1.230-82.3%
J3105Terbutaline sulfate injper 1 MG$2.820$1.000-64.5%
Q5119Inj ruxience, 10 mgper 10 MG$16.160$5.792-64.2%
J8522Capecitabine, oral, 50 mgper 50 MG$0.080$0.029-63.8%
J0877Inj, daptomycin (hospira)per 1 MG$0.057$0.022-61.4%
J8700Temozolomideper 5 MG$0.425$0.208-51.1%
J2778Ranibizumab injectionper 0.1 mg$51.090$26.384-48.4%
J9264Paclitaxel protein boundper 1 MG$6.586$3.640-44.7%
J7631Cromolyn sodium noncomp unitper 10 MG$0.691$0.385-44.3%
J3000Streptomycin injectionper 1 GM$26.883$16.407-39%
J9033Inj, bendamustine (nos) 1mgper 1 MG$2.960$1.846-37.6%
J9261Nelarabine injectionper 50 MG$65.407$40.872-37.5%
J7510Prednisolone oral per 5 mgper 5 MG$0.777$0.498-35.9%
J9293Mitoxantrone hydrochl / 5 mgper 5 MG$29.702$19.418-34.6%
J1790Droperidol injectionper up to 5 MG$8.124$5.348-34.2%
Q5156Inj, tocilizumab-anoh, 1 mgper 1 MG$4.692$3.098-34%
J2251Inj midazolam in 0.9% naclper 1 MG$0.117$0.078-33.3%
J9025Azacitidine injectionper 1 MG$0.401$0.269-32.9%
J2599Inj vasopressin (am reg) 1 uper 1 UNIT$0.834$0.574-31.2%
J1560Gamma globulin > 10 cc injper 10 CC$162.519$118.153-27.3%
J7605Arformoterol non-comp unitper 15 mcg$0.742$0.542-27%
J3360Diazepam injectionper 5 MG$6.854$5.069-26%
J1190Dexrazoxane hcl injectionper 250 MG$41.441$30.832-25.6%
J2246Inj, micafungin (baxter)per 1 MG$0.448$0.334-25.4%
J9351Topotecan injectionper 0.1 MG$2.759$2.067-25.1%

New drug codes

Drug-related HCPCS codes first appearing in this quarter’s CMS file. A new permanent code often replaces billing under an unclassified code (such as J3490, J9999, or C9399) — review claims you billed that way.

Terminated drug codes

Drug-related codes with a termination date recorded this quarter. Check the CMS cross-reference on each code page.

Payment limit file membership

Codes added to or removed from the CMS Part B payment limit file compared with the previous quarter.

Added (37)

  • J0014 Cocaine hcl nasal (goprelto)
  • J0528 Inj fosfomycin disodium 20mg
  • J0643 Inj leucovorin calcium 1 mg
  • J0644 Inj, leucovorin cal (avyxa)
  • J0716 Centruroides immune f(ab)
  • J0841 Inj crotalidae im f(ab')2 eq
  • J0871 Inj, daptomycin (endo) 1mg
  • J1289 Narsoplimab-wuug, 1 mg
  • J1577 Inj, qivigy, 100mg
  • J1737 Inj meloxicam (azurity) 1mg
  • J1957 Injection levetiracetam 5 mg
  • J1958 Inj levetirac sodi chlo 5 mg
  • J2361 Inj depemokimab-ulaa 1 mg
  • J2374 Apraclonidine hcl opht 0.1ml
  • J2789 Riboflavin epioxa/hd<=2ml
  • J3268 Injection, delafloxacin
  • J3404 Inj zopapogene per ther dose
  • J3405 Inj onase abepar-brve treat
  • J7524 Mycophenol mofetil oral 5 mg
  • J7526 Inj mycophenola mofetil 5 mg
  • J7529 Mycop mofetil susp oral 5 mg
  • J7530 Mycophenolat (myhibbin) 5 mg
  • J8541 Oral, hemady, 0.25 mg
  • J9186 Inj etoposide (avyxa), 1 mg
  • J9187 Inj, etoposide, 1 mg
  • J9191 Inj fluorouracil (avyxa)10mg
  • J9192 Inj, fluorouracil, 10 mg
  • J9275 Inj cosibelimab-ipdl, 2 mg
  • J9318 Inj romidepsin non-lyo 0.1mg
  • J9361 Inj, efbemalenograstim alfa-
  • J9362 Inj, trabectedin, 0.01 mg
  • Q0166 Granisetron hcl 1 mg oral
  • Q2058 Obecbtge autol up to 400 mil
  • Q5161 Inj, denosumab-kyqq, 1 mg
  • Q5167 Inj, denosumab-qbde, 1 mg
  • Q5168 Inj. nufymco, 0.1 mg
  • Q5169 Inj, armlupeg, 0.5 mg

Removed (10)

  • 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)

NDC–HCPCS crosswalk changes

NDC-to-code pairs added to or removed from the CMS ASP crosswalk between Q3 2026 and Q4 2026.

Crosswalk changes by HCPCS code
HCPCSNDCs addedNDCs removedExamples
J1953056− 67457-0255-10 · − 63323-0400-44 · − 70860-0604-82
J7517043− 00093-7334-01 · − 00004-0260-43 · − 50268-0557-15
J1958400+ 14789-0330-15 · + 67457-0255-10 · + 65145-0175-10
J0640035− 71288-0162-30 · − 68462-0767-35 · − 70436-0116-82
J0643350+ 70436-0119-80 · + 68001-0418-38 · + 70436-0120-80
J7524350+ 00004-0260-43 · + 59651-0624-01 · + 67877-0266-01
J9190030− 68001-0524-30 · − 63323-0117-18 · − 63323-0117-10
J9192280+ 63323-0117-51 · + 63323-0117-58 · + 70700-0188-22
J9181020− 71288-0175-05 · − 71288-0176-25 · − 63323-0104-06
J9187200+ 63323-0104-05 · + 00143-9512-01 · + 63323-0104-06
J1957150+ 63323-0400-05 · + 72572-0360-25 · + 55150-0177-05
J324607− 25208-0002-03 · − 25208-0002-02 · − 25208-0001-04
J751270+ 68788-8819-01 · + 68788-8663-08 · + 68788-8858-01
J751906− 71288-0803-92 · − 71288-0803-21 · − 67457-0386-81
J752660+ 67457-0386-81 · + 00004-0298-09 · + 42023-0172-04
J752960+ 72603-0751-01 · + 00527-5160-82 · + 23155-0848-51
J917123+ 43066-0048-16 · + 43066-0046-08 · − 16729-0267-64
J069604− 66794-0212-42 · − 66794-0211-42 · − 66794-0215-15
J224840+ 42658-0023-01 · + 42658-0022-01 · + 42658-0023-02
J240440+ 42571-0394-89 · + 70069-0875-10 · + 70069-0876-10
J270431+ 71288-0729-21 · + 71288-0730-51 · + 71288-0731-53
J328504− 42023-0206-01 · − 42023-0207-01 · − 42023-0209-01
J752804− 23155-0848-51 · − 59651-0646-26 · − 67877-0230-22
J921740+ 00074-3346-55 · + 00074-3473-55 · + 00074-3683-55
Q016240+ 62135-0350-05 · + 68788-9559-01 · + 68788-8666-03
Q016704− 60687-0375-21 · − 60687-0375-01 · − 60687-0386-21
J029012+ 72572-0093-10 · − 00781-3400-95 · − 00781-9401-95
J064430+ 83831-0147-05 · + 83831-0148-35 · + 83831-0149-50
J120030+ 42571-0337-87 · + 42571-0511-56 · + 83634-0781-01
J125030+ 00409-1100-10 · + 00409-0151-10 · + 00409-0025-10
J192012+ 83301-0059-01 · − 72611-0734-01 · − 72611-0738-01
J226030+ 65145-0176-10 · + 70069-0872-10 · + 70069-0873-10
J907530+ 68001-0695-32 · + 68001-0696-32 · + 68001-0694-27
J046102− 00409-4910-34 · − 00409-4911-34
J047502− 67457-0563-20 · − 67457-0562-20
J077020+ 00143-9443-12 · + 00143-9443-01
J087220+ 72572-0158-01 · + 00143-9445-01
J087702− 72572-0158-01 · − 00143-9445-01
J088520+ 55513-0267-20 · + 55513-0126-20
J116302− 70860-0301-10 · − 70860-0301-25

Hospital outpatient (OPPS) status changes

Drug codes whose OPPS status indicator changed between the Q3 2026 and Q4 2026 Addendum B — the difference between being paid separately and being packaged into the administration payment.

Drug codes whose OPPS status indicator changed
HCPCSDescriptionStatusWhat it meansRate now
A9521Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuriesE1 → KNow paid separately$927.710
A9600Strontium sr-89 chloride, therapeutic, per millicurieK → E1No longer paid separately—
A9608Flotufolastat f 18, diagnostic, 1 millicurieG → KPass-through ended; still paid separately$292.700
J0184Injection, amisulpride, 1 mgG → NPass-through ended; now packaged (no separate payment)—
J0209Injection, sodium thiosulfate (hope), 100 mgK → E1No longer paid separately—
J0211Injection, sodium nitrite 3 mg and sodium thiosulfate 125 mg (nithiodote)K → E1No longer paid separately—
J0402Injection, aripiprazole (abilify asimtufii), 1 mgG → KPass-through ended; still paid separately$6.185
J0565Injection, bezlotoxumab, 10 mgK → E1No longer paid separately—
J0577Injection, buprenorphine extended-release (brixadi), less than or equal to 7 days of therapyG → KPass-through ended; still paid separately$433.167
J0578Injection, buprenorphine extended release (brixadi), greater than 7 days and up to 28 days of therapyG → KPass-through ended; still paid separately$1,732.667
J0716Injection, centruroides immune f(ab)2, up to 120 milligramsE1 → KNow paid separately$5,449.649
J0841Injection, crotalidae immune f(ab')2 (equine), 120 mgE1 → KNow paid separately$1,084.909
J0891Injection, argatroban (accord), not therapeutically equivalent to j0883, 1 mg (for non-esrd use)K → E2No longer paid separately—
J1304Injection, tofersen, 1 mgG → KPass-through ended; still paid separately$164.812
J2374Apraclonidine hydrochloride ophthalmic, 1% solution, 0.1 mlE1 → NStatus changed—
J2799Injection, risperidone (uzedy), 1 mgG → KPass-through ended; still paid separately$26.227
J7214Injection, factor viii/von willebrand factor complex, recombinant (altuviiio), per factor viii i.u.G → KPass-through ended; still paid separately$4.656
J7314Injection, fluocinolone acetonide, intravitreal implant (yutiq), 0.01 mgK → E1No longer paid separately—
J7330Autologous cultured chondrocytes, implantB → E1Status changed—
J9161Injection, denileukin diftitox-cxdl, 1 mcgE2 → KNow paid separately$12.830
J9232Injection, docetaxel (hospira), not therapeutically equivalent to j9171, 1 mgE2 → KNow paid separately$0.510
J9296Injection, pemetrexed (accord), not therapeutically equivalent to j9305, 10 mgK → E2No longer paid separately—
J9302Injection, ofatumumab, 10 mgK → E1No longer paid separately—
J9313Injection, moxetumomab pasudotox-tdfk, 0.01 mgK → E1No longer paid separately—
J9321Injection, epcoritamab-bysp, 0.16 mgG → KPass-through ended; still paid separately$57.975
J9361Injection, efbemalenograstim alfa-vuxw, 0.5 mgE2 → KNow paid separately$121.430
J9394Injection, fulvestrant (fresenius kabi) not therapeutically equivalent to j9395, 25 mgK → E2No longer paid separately—
Q5154Injection, omalizumab-igec (omlyclo), biosimilar, 5 mgE2 → KNow paid separately$46.610
Q5166Injection, denosumab-desu (osvyrti/jubereq), biosimilar, 1 mgE2 → KNow paid separately$29.720
Q5168Injection, ranibizumab-leyk (nufymco), biosimilar, 0.1 mgE2 → KNow paid separately$26.380
Q5169Injection, pegfilgrastim-unne (armlupeg), biosimilar, 0.5 mgE2 → KNow paid separately$519.480

Pass-through status expiring during the calendar year (18)

  • A9601 Flortaucipir f 18 injection, diagnostic, 1 millicurie
  • J0174 Lecanemab-irmb, for intravenous injection, 1 mg
  • J0177 Injection, aflibercept hd, 1 mg
  • J0217 Injection, velmanase alfa-tycv, 1 mg
  • J0349 Injection, rezafungin, 1 mg
  • J0589 Injection, daxibotulinumtoxina-lanm, 1 unit
  • J1323 Injection, elranatamab-bcmm, 1 mg
  • J1412 Injection, valoctocogene roxaparvovec-rvox, per ml, containing nominal 2 x 10^13 vector genomes
  • J1413 Injection, delandistrogene moxeparvovec-rokl, per therapeutic dose
  • J2508 Injection, pegunigalsidase alfa-iwxj, 1 mg
  • J2782 Injection, avacincaptad pegol, 0.1 mg
  • J3055 Injection, talquetamab-tgvs, 0.25 mg
  • J3401 Beremagene geperpavec-svdt for topical administration, containing nominal 5 x 10^9 pfu/ml vector genomes, per 0.1 ml
  • J7165 Injection, prothrombin complex concentrate, human-lans, per i.u. of factor ix activity
  • J7354 Cantharidin for topical administration, 0.7%, single unit dose applicator (3.2 mg)
  • J9029 Intravesical instillation, nadofaragene firadenovec-vncg, per therapeutic dose
  • J9286 Injection, glofitamab-gxbm, 2.5 mg
  • J9333 Injection, rozanolixizumab-noli, 1 mg

Drug codes new to Addendum B (28)

  • C9311 Injection, eplontersen, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) (status G)
  • C9312 Injection, trabectedin (apotex), not therapeutically equivalent to j9362, 0.01 mg (status G)
  • C9313 Injection, pivekimab sunirine-pvzy, 0.01 mg (status G)
  • J0014 Cocaine hydrochloride nasal solution (goprelto), 1 mg (status N)
  • J0643 Injection, leucovorin calcium, not otherwise specified, 1 mg (status N)
  • J0644 Injection, leucovorin calcium (avyxa), 1 mg (status G)
  • J0871 Injection, daptomycin (endo), not therapeutically equivalent to j0878, 1 mg (status K)
  • J1757 Injection, tividenofusp alfa-eknm, 1 mg (status K)
  • J1818 Injection, pegzilarginase-nbln, 0.05 mg (status K)
  • J1946 Injection, furosemide (lasix onyu), 1 mg (status E1)
  • J1947 Injection, furosemide (furoscix), 1 mg (status E1)
  • J1957 Injection, levetiracetam, 5 mg (status N)
  • J1958 Injection, levetiracetam in sodium chloride, 5 mg (status N)
  • J3268 Injection, delafloxacin, 1 mg (status E2)
  • J3406 Injection, omidubicel-onlv, per therapeutic dose (status K)
  • J7524 Mycophenolate mofetil, oral, 5 mg (status N)
  • J7526 Injection, mycophenolate mofetil, 5 mg (status N)
  • J7529 Mycophenolate mofetil, for suspension, oral, 5 mg (status N)
  • J7530 Mycophenolate mofetil (myhibbin), oral suspension, 5 mg (status N)
  • J7531 Prednisolone sodium phosphate, orally disintegrating tablet, 1 mg (status E1)
  • J9066 Injection, bendamustine hydrochloride (avyxa), 1 mg (status E2)
  • J9186 Injection, etoposide (avyxa), 1 mg (status G)
  • J9187 Injection, etoposide, 1 mg (status N)
  • J9191 Injection, fluorouracil (avyxa), 10 mg (status G)
  • J9192 Injection, fluorouracil, 10 mg (status N)
  • J9362 Injection, trabectedin, 0.01 mg (status K)
  • Q5172 Injection, filgrastim-laha (filkri), biosimilar, 1 microgram (status K)
  • Q5173 Injection, denosumab-adet (ponlimsi), biosimilar, 1 mg (status E2)

Disclaimer. This application provides informational coding and reimbursement reference data. It does not constitute legal, clinical, coding, or billing advice. Codes, payment amounts, payer rules, and coverage policies can change. Verify all information with current CMS publications, the applicable payer, and your organization’s compliance policies before submitting a claim. CodeRx is not affiliated with or endorsed by CMS, FDA, Medicare, or any payer.