HCPCS J0638 has a Medicare Part B payment limit of $156.95 per 1 MG under 2026 Q4 Medicare Part B drug (ASP) pricing, the same in every state.
Payment limit per 1 MG
$156.95
Same in every state
$156.95 per 1 MG in every state. The 2026 Q4 Medicare Part B drug (ASP) pricing sets one national amount for HCPCS J0638; it is not adjusted by locality or by site of service.
Here is how the Medicare Part B drug (ASP) pricing arrives at the HCPCS J0638 amount above, and what it does and doesn't cover.
Medicare pays most physician-administered drugs at a payment limit based on the drug's Average Sales Price (ASP), updated every quarter. The amount is the same nationwide.
$156.95 is paid per 1 MG. A dose of several units bills the code that many times, so the claim pays the per-unit limit × units given.
Commercial payers set their own negotiated rates, and routinely pay above or below the Medicare amount for the same code. See how UHC, Aetna, Cigna and BCBS actually price J0638.
This page reflects the 2026 Q4 CMS Part B drug (ASP) pricing, effective 2026-10-01. Want the full story behind why this data is public at all — the rules, the deadlines, the penalties? Read the price transparency law guide.
Medicare is the floor, not the market. See what UHC, Aetna, Cigna and BCBS actually pay — down to the TIN.