Table III: 2020 Medicare Drug Fee Schedule*

CY 2020 1st Quarter Average Sales Price (ASP) Data Plus 6 Percent

*The Medicare payments allowance limits are effective April 1 through June 30, 2020

CY 2020 CY 2020

Effective Jan. 1 Effective Apr. 1

Through Mar. 31 Through June 30

Code Description Code Dosage ASP plus 6 percent ASP plus 6 percent

J0129 Abatacept 10mg $54.85 $55.08

J0130 Abciximab injection 10mg $1,429.07 $1,429.07

J0133 Acyclovir, 5 mg 5mg $0.05 $0.07

J0171 Adrenalin epinephrin inject 0.1mg $0.82 $0.84

J0207 Amifostine 500mg $1,011.89 $980.14

J0256 Alpha 1 proteinase inhibitor 10mg $4.45 $4.43

J0280 Aminophyllin 250 MG inj 250mg $10.53 $7.11

J0289 Amphotericin b liposome inj 10mg $26.73 $27.23

J0295 Ampicillin sodium per 1.5 gm 1.5gm $2.58 $3.58

J0360 Hydralazine hcl injection 20mg $3.75 $3.77

J0456 Azithromycin 500mg $2.60 $3.11

J0461 Atropine sulfate injection 0.01mg $0.08 $0.06

J0475 Baclofen 10 MG injection 10mg $173.60 $177.65

J0476 Baclofen intrathecal trial 50mcg $60.07 $49.12

J0480 Basiliximab 20mg $3,808.08 $3,805.54

J0490 Belimumab 10mg $45.49 $45.50

J0500 Dicyclomine injection 20mg $53.32 $45.43

J0515 Inj benztropine mesylate 1mg $17.73 $17.26

J0570 Buprenorphine implant 74.2mg $1,211.27 $1,233.14

J0583 Bivalirudin 1mg $0.57 $0.62

J0585 Botulinum toxin a per unit 1unit $6.12 $6.11

J0587 Botulinum toxin type B 100units $11.99 $11.99

J0592 Buprenorphine hydrochloride 0.1mg $4.75 $4.75

J0595 Butorphanol tartrate 1 mg 1mg $2.47 $2.53

J0600 Edetate calcium disodium inj 1000mg $5,594.42 $5,594.42

J0610 Calcium gluconate injection 10ml $3.44 $4.22

J0630 Calcitonin salmon injection 400units $2,656.48 $2,653.46

J0636 Inj calcitriol per 0.1 mcg 0.1mcg $0.74 $0.77

J0637 Caspofungin acetate 5mg $7.03 $6.54

J0640 Leucovorin calcium injection 50mg $3.33 $3.04

J0690 Cefazolin sodium injection 500mg $0.82 $0.82

J0692 Cefepime HCl for injection 500mg $1.78 $1.82

J0694 Cefoxitin sodium injection 1gm $5.29 $7.34

J0696 Ceftriaxone sodium injection 250mg $0.60 $0.53

J0697 Sterile cefuroxime injection 750mg $2.22 $2.13

J0702 Betamethasone acet&sod phosp 3mg $7.07 $7.32

J0713 Inj ceftazidime per 500 mg 500mg $2.03 $1.98

J0717 Certolizum Pegol Inj 1mg $8.21 $7.99

J0720 Chloramphenicol sodium injec 1gm $38.94 $31.89

J0725 Chorionic gonadotropin/1000u 1,000units $21.87 $21.25

J0740 Cidofovir injection 375mg $633.40 $611.07

J0743 Cilastatin sodium injection 250mg $5.69 $6.04

J0770 Colistimethate sodium inj 150mg $19.72 $18.16

J0780 Prochlorperazine injection 10mg $8.64 $7.67

J0800 Corticotropin injection 1-40units $3,923.78 $3,913.09

J0882 Darbepoetin alfa, non-esrd 1mcg $3.82 $3.67

J0885 Non esrd epoetin alpha inj 1,000units $10.56 $10.02

J0895 Deferoxamine mesylate inj 500mg $7.91 $8.28

J0897 Denosumab injection 1 mg $19.28 $19.34

J1000 Depo-estradiol cypionate inj 5mg $21.85 $21.82

J1020 Methylprednisolone 20 MG inj 20mg $3.61 $3.44

J1030 Methylprednisolone 40 MG inj 40mg $6.29 $6.05

J1040 Methylprednisolone 80 MG inj 80mg $11.90 $11.63

J1100 Dexamethasone sodium phos 1mg $0.12 $0.14

J1110 Inj dihydroergotamine mesylt 1mg $54.45 $63.93

J1120 Acetazolamid sodium injectio 50mg $14.14 $14.60

J1160 Digoxin injection 0.5mg $5.58 $4.74

J1165 Phenytoin sodium injection 50mg $0.98 $0.83

J1190 Dexrazoxane HCl injection 250mg $197.52 $194.32

J1200 Diphenhydramine hcl injectio 1-50mg $0.90 $0.84

J1205 Chlorothiazide sodium inj 500mg $50.14 $59.76

J1230 Methadone injection 10mg $16.97 $17.42

J1245 Dipyridamole injection 10mg $2.99 $2.36

J1250 Inj dobutamine HCL/250 mg 250mg $6.08 $5.72

J1265 DopAMIne injection 40mg $0.72 $0.60

J1270 Injection, doxercalciferol 1mcg $0.38 $0.28

J1325 Epoprostenol injection 0.5mg $16.16 $16.18

J1335 Ertapenem injection 500mg $38.70 $38.45

J1364 Erythro lactobionate /500 MG 500mg $75.23 $73.40

J1410 Inj estrogen conjugate 25 MG 25mg $308.70 $308.38

J1430 Ethanolamine oleate 100 mg 100mg $444.10 $444.10

J1450 Fluconazole 200mg $4.68 $12.87

J1566 Inj immune globulin, lyophilzed 500mg 500mg $63.19 $70.49

J1570 Ganciclovir sodium injection 500mg $34.64 $14.51

J1580 Garamycin gentamicin inj 80mg $1.97 $2.05

J1610 Glucagon hydrochloride/1 MG 1mg $217.56 $199.88

J1626 Granisetron HCl injection 100mcg $0.24 $0.29

J1630 Haloperidol injection 5mg $1.21 $0.83

J1631 Haloperidol decanoate inj 50mg $16.28 $15.45

J1642 Inj heparin sodium per 10 u 10units $0.32 $0.02

J1644 Inj heparin sodium per 1000u 1000units $0.24 $0.25

J1645 Dalteparin sodium 2500I.U. $12.57 $11.73

J1650 Inj enoxaparin sodium 10mg $0.67 $0.71

J1652 Fondaparinux sodium 0.5mg $1.52 $1.57

J1720 Hydrocortisone sodium succ i 100mg $13.05 $12.90

J1740 Ibandronate sodium 1mg $44.27 $43.73

J1742 Ibutilide fumarate injection 1mg $258.22 $242.01

J1745 Infliximab injection 10mg $57.35 $55.70

J1756 Iron sucrose injection 1mg $0.21 $0.21

J1786 Imuglucerase injection 10units $42.64 $42.62

J1800 Propranolol injection 1mg $1.88 $3.40

J1815 Insulin injection 5units $0.90 $0.89

J1817 Insulin for insulin pump use 50units $10.78 $10.66

J1940 Furosemide injection 20mg $0.59 $0.63

J1950 Leuprolide acetate /3.75 MG 3.75mg $1,271.10 $1,299.24

J1955 Inj levocarnitine per 1 gm 1gm $19.82 $20.45

J1956 Levofloxacin injection 250mg $0.66 $0.43

J1980 Hyoscyamine sulfate inj 0.25mg $31.60 $31.60

J2001 Lidocaine injection 10mg $0.03 $0.03

J2010 Lincomycin injection 300mg $13.36 $12.23

J2020 Linezolid injection 200mg $5.56 $6.23

J2060 Lorazepam injection 2mg $0.70 $0.75

J2150 Mannitol injection 50ml $2.02 $2.11

J2185 Meropenem 100mg $0.80 $0.81

J2210 Methylergonovin maleate inj 0.2mg $18.04 $17.93

J2250 Inj midazolam hydrochloride 1mg $0.12 $0.11

J2260 Inj milrinone lactate / 5 MG 5mg $1.53 $1.66

J2310 Inj naloxone hydrochloride 1mg $13.28 $12.36

J2353 Octreotide injection, depot 1mg $206.09 $206.08

J2354 Octreotide inj, non-depot 25mcg $0.94 $0.85

J2400 Chloroprocaine hcl injection 30ml $24.41 $26.40

J2405 Ondansetron hcl injection 1mg $0.09 $0.09

J2430 Pamidronate disodium /30 MG 30mg $11.06 $10.34

J2501 Paricalcitol 1mcg $0.77 $0.83

J2505 Injection, pegfilgrastim 6mg 6mg $4,257.10 $3,983.14

J2507 Pegloticase injection 1mg 1mg $2,621.77 $2,590.90

J2510 Penicillin g procaine inj 600,000units $29.63 $29.68

J2515 Pentobarbital sodium inj 50mg $34.98 $37.25

J2543 Piperacillin/tazobactam 1.125gm $1.85 $1.83

J2560 Phenobarbital sodium inj 120mg $42.39 $41.93

J2597 Inj desmopressin acetate 1mcg $11.52 $11.30

J2675 Inj progesterone per 50 MG 50mg $1.84 $1.69

J2680 Fluphenazine decanoate 25 MG 25mg $9.98 $11.21

J2690 Procainamide hcl injection 1gm $97.26 $97.32

J2700 Oxacillin sodium injection 250mg $1.31 $1.11

J2765 Metoclopramide hcl injection 10mg $1.20 $1.24

J2770 Quinupristin/dalfopristin 500mg $417.77 $416.42

J2780 Ranitidine hydrochloride inj 25mg $4.14 $3.84

J2783 Rasburicase 0.5mg $292.33 $292.71

J2788 Rho d immune globulin 50 mcg 50mcg $25.25 $26.13

J2792 Rho(D) immune globulin h, sd 100IU $29.79 $28.74

J2795 Ropivacaine HCl injection 1mg $0.08 $0.08

J2820 Sargramostim injection 50mcg $43.50 $46.77

J2916 Na ferric gluconate complex 12.5mg $1.99 $1.97

J2920 Methylprednisolone injection 40mg $4.58 $4.48

J2930 Methylprednisolone injection 125mg $6.32 $6.39

J2997 Alteplase recombinant 1mg $87.85 $87.70

J3010 Fentanyl citrate injection 0.1mg $0.99 $0.79

J3101 Tenecteplase injection 1mg $125.42 $125.55

J3105 Terbutaline sulfate inj 1mg $2.12 $2.05

J3230 Chlorpromazine hcl injection 50mg $31.56 $31.16

J3240 Thyrotropin injection 0.9mg_1.1mg $1,700.41 $1,700.91

J3250 Trimethobenzamide hcl inj 200mg $36.46 $36.62

J3260 Tobramycin sulfate injection 80mg $3.69 $3.97

J3262 Tocilizumab injection 1mg $5.08 $5.09

J3285 Treprostinil, 1 mg 1mg $62.51 $61.64

J3301 Triamcinolone acetonide inj 10mg $1.56 $1.50

J3315 Triptorelin pamoate 3.75mg $263.74 $268.43

J3360 Diazepam injection 5mg $9.42 $9.40

J3370 Vancomycin hcl injection 500mg $3.39 $2.97

J3396 Verteporfin injection 0.1mg $11.11 $11.11

J3410 Hydroxyzine hcl injection 25mg $7.02 $6.33

J3420 Vitamin b12 injection 1000mcg $2.21 $2.26

J3430 Vitamin k phytonadione inj 1mg $4.23 $4.11

J3465 Injection, voriconazole 10mg $2.11 $1.75

J3475 Inj magnesium sulfate 500mg $0.63 $0.55

J3480 Inj potassium chloride 2meq $0.14 $0.13

J3485 Zidovudine 10mg $1.51 $1.51

J3486 Ziprasidone mesylate 10mg $17.96 $16.83

J3489 Zoledronic acid 1mg $10.88 $13.29

J7030 Normal saline solution infus 1000cc $2.59 $2.59

J7040 Normal saline solution infus 500ML $1.29 $1.30

J7042 5% dextrose/normal saline 500ML $0.93 $1.02

J7050 Normal saline solution infus 250cc $0.65 $0.65

J7060 5% dextrose/water 500ML $1.82 $1.90

J7070 D5w infusion 1000cc $3.61 $3.77

J7120 Ringers lactate infusion 1000cc $2.36 $2.41

J7189 Factor viia recombinant 1mcg $2.16 $2.17

J7190 Factor viii 1I.U. $1.10 $1.05

J7192 Factor viii recombinant 1I.U. $1.29 $1.27

J7193 Factor IX non-recombinant 1I.U. $1.17 $1.16

J7194 Factor ix complex 1I.U. $1.48 $1.51

J7195 Factor IX recombinant 1I.U. $1.53 $1.52

J7197 Antithrombin iii injection 1I.U. $3.28 $3.61

J7198 Anti-inhibitor 1I.U. $1.87 $1.93

J7308 Aminolevulinic acid hcl top 354mg $392.38 $395.24

J7321 Hyalgan or Supartz, inj PER DOSE $82.85 $82.64

J7323 Euflexxa, inj PER DOSE $144.69 $141.22

J7324 Orthovisc, inj PER DOSE $140.42 $135.03

J7325 Synvisc and Synvisc-One 1mg $11.03 $11.00

J7500 Azathioprine oral 50mg 50mg $0.66 $0.69

J7502 Cyclosporine oral 100 mg 100mg $2.38 $2.58

J7504 Lymphocyte immune globulin 250mg $2,060.04 $2,053.22

J7507 Tacrolimus oral per 1 MG 1mg $0.69 $0.74

J7509 Methylprednisolone oral 4mg $0.35 $0.42

J7511 Antithymocyte globuln rabbit 25mg $765.74 $770.52

J7516 Cyclosporin parenteral 250mg 250mg $58.75 $58.57

J7517 Mycophenolate mofetil oral 250mg $0.72 $0.52

J7520 Sirolimus, oral 1mg $6.00 $5.61

J7525 Tacrolimus injection 5mg $211.60 $211.75

J7608 Acetylcysteine inh sol u d 1gm $5.69 $5.50

J7626 Budesonide inhalation sol 0.25-0.50mg $1.74 $1.74

J7631 Cromolyn sodium inh sol u d 10mg $4.90 $2.14

J7639 Dornase alpha inhal sol u d 1mg $47.79 $47.79

J7644 Ipratropium brom inh sol u d 1mg $0.20 $0.21

J7682 Tobramycin inhalation sol 300mg $39.93 $34.25

J8520 Capecitabine, oral, 150 mg 150mg $0.78 $0.62

J8521 Capecitabine, oral, 500 mg 500mg $2.73 $2.46

J8530 Cyclophosphamide oral 25 MG 25mg $2.65 $2.45

J8560 Etoposide oral 50 MG 50mg $75.27 $74.61

J8610 Methotrexate oral 2.5 MG 2.5mg $0.23 $0.23

J8700 Temozolomide 5mg $0.91 $0.63

J9000 Doxorubic hcl 10 MG vl chemo 10mg $2.87 $3.00

J9017 Arsenic trioxide 1mg $44.07 $30.23

J9034 Bendeka inj 1mg $21.73 $21.18

J9040 Bleomycin sulfate injection 15units $22.67 $25.47

J9045 Carboplatin injection 50mg $2.69 $2.79

J9050 Carmus bischl nitro inj 200mg $2,618.62 $1,927.69

J9060 Cisplatin 10 MG injection 10mg $1.93 $1.91

J9065 Inj cladribine per 1 MG 1mg $20.18 $18.64

J9070 Cyclophosphamide 500 MG inj 100mg $33.24 $31.85

J9100 Cytarabine hcl 100 MG inj 100mg $0.81 $0.66

J9120 Dactinomycin actinomycin d 0.5mg $1,106.46 $975.14

J9145 Daratumumab inj 10mg $54.03 $54.15

J9150 Daunorubicin 10mg $48.40 $46.34

J9171 Docetaxel injection 1mg $0.97 $1.04

J9176 Elotozumab inj 1mg $6.58 $6.58

J9178 Inj, epirubicin hcl, 2 mg 2mg $1.12 $1.21

J9181 Etoposide 10 MG inj 10mg $0.62 $0.61

J9185 Fludarabine phosphate inj 50mg $47.89 $44.74

J9190 Fluorouracil injection 500mg $1.51 $1.75

J9200 Floxuridine injection 500mg $85.37 $77.31

J9201 Gemcitabine HCl 200mg $4.16 $3.86

J9202 Goserelin acetate implant 3.6mg $503.98 $500.31

J9205 Irinotecan liposome inj 1mg $49.84 $49.78

J9206 Irinotecan injection 20mg $2.48 $2.49

J9208 Ifosfomide injection 1gm $26.70 $26.25

J9209 Mesna injection 200mg $2.22 $0.67

J9211 Idarubicin hcl injection 5mg $36.31 $33.11

J9214 Interferon alfa-2b inj 1millionunits $34.21 $33.55

J9217 Leuprolide acetate suspnsion 7.5mg $230.07 $235.37

J9218 Leuprolide acetate injection 1mg $10.13 $12.39

J9245 Inj melphalan hydrochl 50 MG 50mg $633.40 $521.37

J9250 Methotrexate sodium inj 5mg $0.25 $0.24

J9260 Methotrexate sodium inj 50mg $2.49 $2.35

J9263 Oxaliplatin 0.5mg $0.15 $0.14

J9268 Pentostatin injection 10mg $2,109.35 $2,054.65

J9280 Mitomycin 5 MG inj 5mg $79.89 $64.63

J9293 Mitoxantrone hydrochl / 5 MG 5mg $27.81 $29.42

J9295 Necitumumab inj 1mg $5.74 $5.73

J9311 Inj, rixtuximab, hyaluronidase 10mg $42.87 $42.43

J9312 Inj., rixtuximab, 10mg 10mg $94.41 $94.18

J9320 Streptozocin injection 1gm $352.65 $351.45

J9325 talimogene loherparepvec 1million pfu $51.44 $51.53

J9352 Trabectedin inj 0.1mg $312.94 $312.94

J9355 Trastuzumab 10mg $105.86 $104.20

J9360 Vinblastine sulfate inj 1mg $3.89 $3.87

J9370 Vincristine sulfate 1 MG inj 1mg $4.88 $4.87

J9390 Vinorelbine tartrate/10 mg 20mg $11.96 $3.72

J9395 Injection, Fulvestrant 25mg $84.96 $56.46

Q0167 Dronabinol 2.5mg oral 2.5mg $0.69 $0.78

Q5103 Infliximab biosimiolar inj, inflectra 10mg $57.28 $47.78

Q5104 Injection, renflexis 10mg $61.90 $49.85

This information is from the CMS website dated March 6, 2020.