Table III: 2019 Medicare Drug Fee Schedule*

CY 2019 1st Quarter Average Sales Price (ASP) Data Plus 6 Percent

*The Medicare payments allowance limits are effective Jan. 1 thru March. 31, 2019.

CY 2019

Effective Jan. 1

Through Mar. 31

Code Description Code Dosage ASP plus 6 percent

J0129 Abatacept 10mg $51.61

J0130 Abciximab injection 10mg $1,429.07

J0133 Acyclovir, 5 mg 5mg $0.05

J0171 Adrenalin epinephrin inject 0.1mg $0.74

J0207 Amifostine 500mg $979.75

J0256 Alpha 1 proteinase inhibitor 10mg $4.55

J0280 Aminophyllin 250 MG inj 250mg $7.02

J0289 Amphotericin b liposome inj 10mg $22.19

J0295 Ampicillin sodium per 1.5 gm 1.5gm $2.62

J0360 Hydralazine hcl injection 20mg $2.58

J0456 Azithromycin 500mg $2.76

J0461 Atropine sulfate injection 0.01mg $0.07

J0475 Baclofen 10 MG injection 10mg $169.75

J0476 Baclofen intrathecal trial 50mcg $44.35

J0480 Basiliximab 20mg $3,677.61

J0490 Belimumab 10mg $44.16

J0500 Dicyclomine injection 20mg $69.65

J0515 Inj benztropine mesylate 1mg $18.67

J0570 Buprenorphine implant 74.2mg $1,269.91

J0583 Bivalirudin 1mg $0.80

J0585 Botulinum toxin a per unit 1unit $6.14

J0587 Botulinum toxin type B 100units $12.00

J0592 Buprenorphine hydrochloride 0.1mg $4.15

J0595 Butorphanol tartrate 1 mg 1mg $2.62

J0600 Edetate calcium disodium inj 1000mg $5,594.42

J0610 Calcium gluconate injection 10ml $4.36

J0630 Calcitonin salmon injection 400units $2,651.10

J0636 Inj calcitriol per 0.1 mcg 0.1mcg $0.45

J0637 Caspofungin acetate 5mg $10.02

J0640 Leucovorin calcium injection 50mg $3.35

J0690 Cefazolin sodium injection 500mg $0.83

J0692 Cefepime HCl for injection 500mg $2.47

J0694 Cefoxitin sodium injection 1gm $3.54

J0696 Ceftriaxone sodium injection 250mg $0.65

J0697 Sterile cefuroxime injection 750mg $2.09

J0702 Betamethasone acet&sod phosp 3mg $6.89

J0713 Inj ceftazidime per 500 mg 500mg $2.10

J0717 Certolizum Pegol Inj 1mg $7.89

J0720 Chloramphenicol sodium injec 1gm $39.34

J0725 Chorionic gonadotropin/1000u 1,000units $22.60

J0740 Cidofovir injection 375mg $522.74

J0743 Cilastatin sodium injection 250mg $6.95

J0770 Colistimethate sodium inj 150mg $15.30

J0780 Prochlorperazine injection 10mg $10.06

J0800 Corticotropin injection 1-40units $3,976.02

J0882 Darbepoetin alfa, non-esrd 1mcg $3.83

J0885 Non esrd epoetin alpha inj 1,000units $11.95

J0895 Deferoxamine mesylate inj 500mg $9.62

J0897 Denosumab injection 1 mg $18.61

J1000 Depo-estradiol cypionate inj 5mg $21.94

J1020 Methylprednisolone 20 MG inj 20mg $4.01

J1030 Methylprednisolone 40 MG inj 40mg $6.60

J1040 Methylprednisolone 80 MG inj 80mg $12.86

J1100 Dexamethasone sodium phos 1mg $0.11

J1110 Inj dihydroergotamine mesylt 1mg $14.18

J1120 Acetazolamid sodium injectio 50mg $14.18

J1160 Digoxin injection 0.5mg $4.87

J1165 Phenytoin sodium injection 50mg $1.04

J1190 Dexrazoxane HCl injection 250mg $220.97

J1200 Diphenhydramine hcl injectio 1-50mg $0.54

J1205 Chlorothiazide sodium inj 500mg $73.20

J1230 Methadone injection 10mg $73.20

J1245 Dipyridamole injection 10mg $1.67

J1250 Inj dobutamine HCL/250 mg 250mg $7.32

J1265 DopAMIne injection 40mg $0.82

J1270 Injection, doxercalciferol 1mcg $0.47

J1325 Epoprostenol injection 0.5mg $16.16

J1335 Ertapenem injection 500mg $53.61

J1364 Erythro lactobionate /500 MG 500mg $78.87

J1410 Inj estrogen conjugate 25 MG 25mg $308.91

J1430 Ethanolamine oleate 100 mg 100mg $444.10

J1450 Fluconazole 200mg $5.57

J1566 Inj immune globulin, lyophilzed 500mg 500mg $43.11

J1570 Ganciclovir sodium injection 500mg $56.25

J1580 Garamycin gentamicin inj 80mg $1.69

J1610 Glucagon hydrochloride/1 MG 1mg $219.92

J1626 Granisetron HCl injection 100mcg $0.44

J1630 Haloperidol injection 5mg $1.09

J1631 Haloperidol decanoate inj 50mg $17.39

J1642 Inj heparin sodium per 10 u 10units $0.18

J1644 Inj heparin sodium per 1000u 1000units $0.20

J1645 Dalteparin sodium 2500I.U. $13.94

J1650 Inj enoxaparin sodium 10mg $0.77

J1652 Fondaparinux sodium 0.5mg $2.07

J1720 Hydrocortisone sodium succ i 100mg $12.99

J1740 Ibandronate sodium 1mg $55.44

J1742 Ibutilide fumarate injection 1mg $235.48

J1745 Infliximab injection 10mg $76.95

J1756 Iron sucrose injection 1mg $0.24

J1786 Imuglucerase injection 10units $42.12

J1800 Propranolol injection 1mg $3.66

J1815 Insulin injection 5units $0.89

J1817 Insulin for insulin pump use 50units $10.95

J1940 Furosemide injection 20mg $0.83

J1950 Leuprolide acetate /3.75 MG 3.75mg $1,188.99

J1955 Inj levocarnitine per 1 gm 1gm $20.56

J1956 Levofloxacin injection 250mg $1.47

J1980 Hyoscyamine sulfate inj 0.25mg $30.29

J2001 Lidocaine injection 10mg $0.05

J2010 Lincomycin injection 300mg $13.46

J2020 Linezolid injection 200mg $8.51

J2060 Lorazepam injection 2mg $0.73

J2150 Mannitol injection 50ml $3.80

J2185 Meropenem 100mg $1.03

J2210 Methylergonovin maleate inj 0.2mg $15.77

J2250 Inj midazolam hydrochloride 1mg $0.13

J2260 Inj milrinone lactate / 5 MG 5mg $1.40

J2310 Inj naloxone hydrochloride 1mg $17.72

J2353 Octreotide injection, depot 1mg $197.88

J2354 Octreotide inj, non-depot 25mcg $0.91

J2400 Chloroprocaine hcl injection 30ml $28.78

J2405 Ondansetron hcl injection 1mg $0.17

J2430 Pamidronate disodium /30 MG 30mg $11.91

J2501 Paricalcitol 1mcg $0.64

J2505 Injection, pegfilgrastim 6mg 6mg $4,681.81

J2507 Pegloticase injection 1mg 1mg $2,361.05

J2510 Penicillin g procaine inj 600,000units $29.29

J2515 Pentobarbital sodium inj 50mg $48.29

J2543 Piperacillin/tazobactam 1.125gm $1.94

J2560 Phenobarbital sodium inj 120mg $39.20

J2597 Inj desmopressin acetate 1mcg $12.46

J2675 Inj progesterone per 50 MG 50mg $1.85

J2680 Fluphenazine decanoate 25 MG 25mg $15.44

J2690 Procainamide hcl injection 1gm $77.30

J2700 Oxacillin sodium injection 250mg $1.93

J2765 Metoclopramide hcl injection 10mg $1.92

J2770 Quinupristin/dalfopristin 500mg $417.76

J2780 Ranitidine hydrochloride inj 25mg $5.06

J2783 Rasburicase 0.5mg $279.82

J2788 Rho d immune globulin 50 mcg 50mcg $28.62

J2792 Rho(D) immune globulin h, sd 100IU $27.78

J2795 Ropivacaine HCl injection 1mg $0.09

J2810 Inj theophylline per 40 MG 40mg $0.33

J2820 Sargramostim injection 50mcg $38.96

J2916 Na ferric gluconate complex 12.5mg $1.94

J2920 Methylprednisolone injection 40mg $4.87

J2930 Methylprednisolone injection 125mg $6.93

J2997 Alteplase recombinant 1mg $87.75

J3010 Fentanyl citrate injection 0.1mg $0.83

J3101 Tenecteplase injection 1mg $121.81

J3105 Terbutaline sulfate inj 1mg $2.68

J3230 Chlorpromazine hcl injection 50mg $30.34

J3240 Thyrotropin injection 0.9mg_1.1mg $1,653.59

J3250 Trimethobenzamide hcl inj 200mg $32.77

J3260 Tobramycin sulfate injection 80mg $2.91

J3262 Tocilizumab injection 1mg $4.93

J3285 Treprostinil, 1 mg 1mg $66.12

J3301 Triamcinolone acetonide inj 10mg $1.70

J3315 Triptorelin pamoate 3.75mg $244.49

J3360 Diazepam injection 5mg $6.88

J3370 Vancomycin hcl injection 500mg $4.23

J3396 Verteporfin injection 0.1mg $10.98

J3410 Hydroxyzine hcl injection 25mg $6.36

J3420 Vitamin b12 injection 1000mcg $1.74

J3430 Vitamin k phytonadione inj 1mg $4.23

J3465 Injection, voriconazole 10mg $1.78

J3475 Inj magnesium sulfate 500mg $0.55

J3480 Inj potassium chloride 2meq $0.14

J3485 Zidovudine 10mg $1.51

J3486 Ziprasidone mesylate 10mg $10.10

J3489 Zoledronic acid 1mg $12.74

J7030 Normal saline solution infus 1000cc $2.52

J7040 Normal saline solution infus 500ML $1.26

J7042 5% dextrose/normal saline 500ML $1.00

J7050 Normal saline solution infus 250cc $0.63

J7060 5% dextrose/water 500ML $2.48

J7070 D5w infusion 1000cc $4.56

J7120 Ringers lactate infusion 1000cc $2.45

J7189 Factor viia recombinant 1mcg $2.08

J7190 Factor viii 1I.U. $1.08

J7192 Factor viii recombinant 1I.U. $1.30

J7193 Factor IX non-recombinant 1I.U. $1.14

J7194 Factor ix complex 1I.U. $1.43

J7195 Factor IX recombinant 1I.U. $1.50

J7197 Antithrombin iii injection 1I.U. $3.50

J7198 Anti-inhibitor 1I.U. $2.00

J7308 Aminolevulinic acid hcl top 354mg $404.59

J7321 Hyalgan or Supartz, inj PER DOSE $79.91

J7323 Euflexxa, inj PER DOSE $141.02

J7324 Orthovisc, inj PER DOSE $146.91

J7325 Synvisc and Synvisc-One 1mg $11.86

J7500 Azathioprine oral 50mg 50mg $0.89

J7502 Cyclosporine oral 100 mg 100mg $2.45

J7504 Lymphocyte immune globulin 250mg $2,066.12

J7507 Tacrolimus oral per 1 MG 1mg $0.58

J7509 Methylprednisolone oral 4mg $0.40

J7511 Antithymocyte globuln rabbit 25mg $731.32

J7515 Cyclosporine oral 25 mg 25mg $0.72

J7516 Cyclosporin parenteral 250mg 250mg $48.89

J7517 Mycophenolate mofetil oral 250mg $1.03

J7520 Sirolimus, oral 1mg $7.23

J7525 Tacrolimus injection 5mg $206.01

J7608 Acetylcysteine inh sol u d 1gm $5.07

J7626 Budesonide inhalation sol 0.25-0.50mg $2.24

J7631 Cromolyn sodium inh sol u d 10mg $5.58

J7639 Dornase alpha inhal sol u d 1mg $47.79

J7644 Ipratropium brom inh sol u d 1mg $0.21

J7682 Tobramycin inhalation sol 300mg $39.67

J8510 Oral busulfan 2mg $24.13

J8520 Capecitabine, oral, 150 mg 150mg $1.15

J8521 Capecitabine, oral, 500 mg 500mg $3.67

J8530 Cyclophosphamide oral 25 MG 25mg $4.54

J8560 Etoposide oral 50 MG 50mg $75.76

J8610 Methotrexate oral 2.5 MG 2.5mg $0.38

J8700 Temozolomide 5mg $0.87

J9000 Doxorubic hcl 10 MG vl chemo 10mg $3.06

J9017 Arsenic trioxide 1mg $46.91

J9031 Bcg live intravesical vac per installation $140.00

J9034 Bendeka inj 1mg $140.28

J9040 Bleomycin sulfate injection 15units $28.77

J9045 Carboplatin injection 50mg $3.25

J9050 Carmus bischl nitro inj 200mg $4,052.35

J9060 Cisplatin 10 MG injection 10mg $1.85

J9065 Inj cladribine per 1 MG 1mg $21.88

J9070 Cyclophosphamide 500 MG inj 100mg $37.82

J9100 Cytarabine hcl 100 MG inj 100mg $0.77

J9120 Dactinomycin actinomycin d 0.5mg $1,455.38

J9145 Daratumumab inj 10mg $52.30

J9150 Daunorubicin 10mg $48.17

J9171 Docetaxel injection 1mg $1.34

J9176 Elotozumab inj 1mg $6.40

J9178 Inj, epirubicin hcl, 2 mg 2mg $1.19

J9181 Etoposide 10 MG inj 10mg $0.70

J9185 Fludarabine phosphate inj 50mg $79.51

J9190 Fluorouracil injection 500mg $1.79

J9200 Floxuridine injection 500mg $75.59

J9201 Gemcitabine HCl 200mg $5.93

J9202 Goserelin acetate implant 3.6mg $501.20

J9205 Irinotecan liposome inj 1mg $45.65

J9206 Irinotecan injection 20mg $2.86

J9208 Ifosfomide injection 1gm $25.45

J9209 Mesna injection 200mg $2.10

J9211 Idarubicin hcl injection 5mg $32.80

J9214 Interferon alfa-2b inj 1millionunits $34.03

J9217 Leuprolide acetate suspnsion 7.5mg $236.15

J9218 Leuprolide acetate injection 1mg $20.49

J9230 Mechlorethamine hcl inj 10mg $320.09

J9245 Inj melphalan hydrochl 50 MG 50mg $804.63

J9250 Methotrexate sodium inj 5mg $0.25

J9260 Methotrexate sodium inj 50mg $2.52

J9263 Oxaliplatin 0.5mg $0.19

J9268 Pentostatin injection 10mg $2,017.33

J9280 Mitomycin 5 MG inj 5mg $125.07

J9293 Mitoxantrone hydrochl / 5 MG 5mg $27.58

J9295 Necitumumab inj 1mg $5.61

J9311 Inj, rixtuximab, hyaluronidase 10mg $46.64

J9312 Inj., rixtuximab, 10mg 10mg $95.40

J9320 Streptozocin injection 1gm $346.38

J9325 talimogene loherparepvec 1million pfu $50.05

J9352 Trabectedin inj 0.1mg $300.63

J9355 Trastuzumab 10mg $107.00

J9360 Vinblastine sulfate inj 1mg $3.69

J9370 Vincristine sulfate 1 MG inj 1mg $4.95

J9390 Vinorelbine tartrate/10 mg 20mg $8.27

J9395 Injection, Fulvestrant 25mg $97.49

Q0167 Dronabinol 2.5mg oral 2.5mg $1.17

Q5103 Infliximab biosimiolar inj, inflectra 10mg $57.28

Q5104 Injection, renflexis 10mg $61.90

This information is from the CMS website dated December 12, 2018.