Medicare Part B Drug Payment (ASP)
What Medicare allows and pays for a Part B drug.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- HCPCS code of the drug
- J9035
- Units billed
- 10 HCPCS dosage units
- Payment limit per unit from another quarter
- 75.492 USD
- Coinsurance with that limit
- 20 percent
Result: J9035: payment limit $75.492 per unit (entered), times 10 = $754.92 allowed. Patient coinsurance 20% = $150.98; Medicare pays $603.94, $591.86 after the 2% sequestration reduction.
The tool opens with these values already filled in. Replace them with your own.
What you enter
- HCPCS code of the drug
- Date of service (YYYY-MM-DD)
- Units billed
- Payment limit per unit from another quarter
- Coinsurance with that limit
How this is calculated
Citation
42 U.S.C. 1395w-3a(b)(1) and (b)(8): Part B drugs paid at 106% of ASP, a biosimilar at its ASP plus 8% or 6% of the reference product's ASP; the payment limit and coinsurance as posted in the CMS quarterly payment limit file; the 2% sequestration reduction. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.