What Will I Pay for a Part B Drug?
What a patient 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
- J0897
- Units billed
- 120 HCPCS dosage units
- Payment limit per unit from another quarter
- 29.856 USD
- Coinsurance with that limit
- 17.885 percent
Result: Medicare allows $3,582.72 for J0897. You pay $640.77 coinsurance, 17.885% of the allowed amount: an inflation reduction lowered it from 20% because the drug's price rose faster than inflation.
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
- Months of pump insulin supplied
- Payment limit per unit from another quarter
- Coinsurance with that limit
How this is calculated
Citation
CMS quarterly Part B payment limit file (limit and coinsurance per code, including inflation-adjusted coinsurance); 42 U.S.C. 1395l(a) and (b)(13): pump insulin coinsurance capped at $35 a month, with no deductible, from July 1, 2023. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.