Addendum Q - Proposed CY 2026 Payment Rates for Drugs Qualifying for Add-on Payment to IHS and Tribal Hospitals Based on CY 2025 AIR		
"The HCPCS codes in Addendum Q represent drugs and biologicals with a per day cost (cost per unit * units per day) above our final threshold of two times the CY 2025 AIR ($1,436). Because the below payment rates reflects the payment per unit, they may be below $1,436."		
*CPT codes and descriptions only are copyright 2025 American Medical Association. All Rights Reserved.Applicable FARS/DFARS Apply. 		
HCPCS Code	Short Descriptor	Payment Rate
90375	Rabies ig im/sc	$273.504
90376	Rabies ig heat treated	$346.070
90377	Rabies ig ht&sol human im/sc	$227.498
90396	Varicella-zoster ig im	"$2,126.646"
A9507	In111 capromab	"$1,545.730"
A9513	Lutetium Lu 177 dotatat ther	$279.480
A9515	"Choline C 11, diagnostic"	"$2,062.940"
A9517	"I131 iodide cap, rx"	$24.410
A9530	"I131 iodide sol, rx"	$21.160
A9532	"I125 serum albumin, dx"	$469.060
A9543	"Y90 ibritumomab, rx"	"$53,608.065"
A9553	Cr51 chromate	"$1,717.620"
A9572	Indium In-111 pentetreotide	"$2,027.500"
A9582	Iodine I-123 iobenguane	"$2,418.900"
A9586	Florbetapir F18	"$1,881.870"
A9587	Gallium Ga-68	$49.230
A9588	Fluciclovine F-18	$329.370
A9591	Fluoroestradiol F 18	$463.200
A9593	Gallium ga-68 psma-11 ucsf	$559.370
A9594	"Gallium ga-68 psma-11, ucla"	$363.510
A9595	"Piflu f-18, dia 1 millicurie"	$347.360
A9596	Gallium illuccix 1 millicure	$485.510
A9600	Sr89 strontium	"$3,911.637"
A9601	Flortaucipir inj 1 millicuri	"$3,500.000"
A9602	Fluorodopa f-18 diag per mci	$862.660
A9604	Sm 153 lexidronam	"$3,161.570"
A9606	Radium Ra223 dichloride ther	$159.488
A9607	Lutetium lu 177 vipivotide	$226.605
A9608	Flotufolastat f18 diag 1 mci	$279.047
A9611	"Flurpiridaz f18, diag, 1 mci"	$500.000
A9615	"Inj, pegulicianine, 1 mg"	$35.385
A9800	Gallium locametz 1 millicuri	$341.950
C9047	"Injection, caplacizumab-yhdp"	$810.130
C9067	Gallium ga-68 Dotatoc	$3.600
J0129	Abatacept injection	$40.922
J0139	"Inj, adalimumab, 1 mg"	$86.533
J0172	"Inj, aducanumab-avwa, 2 mg"	$5.640
J0177	"Inj, aflibercept hd, 1 mg"	$302.996
J0178	Aflibercept injection	$750.812
J0179	"Inj, brolucizumab-dbll, 1 mg"	$320.743
J0180	Agalsidase beta injection	$210.226
J0202	"Injection, Alemtuzumab"	"$2,303.295"
J0206	Inj allopurinol sodium 1 mg	$4.198
J0208	"Inj, pedmark, 100 mg"	$89.997
J0217	Inj velmanase alfa-tycv 1 mg	$419.789
J0218	Inj olipudase alfa-rpcp 1mg	$359.658
J0219	Inj aval alfa-nqpt 4mg	$73.412
J0221	Lumizyme injection	$190.157
J0222	"Inj., patisiran, 0.1 mg"	$93.433
J0223	"Injection, givosiran"	$109.878
J0224	"Inj. lumasiran, 0.5 mg"	$300.804
J0225	"Inj, vutrisiran, 1 mg"	"$4,675.764"
J0256	Alpha 1 proteinase inhibitor	$4.868
J0257	Glassia injection	$5.140
J0349	"Inj, rezafungin, 1 mg"	$9.828
J0391	"Inj, artesunate, 1mg"	$48.895
J0401	"Inj, abilify maintena, 1 mg"	$6.635
J0402	"Inj, abilify asimtufii, 1 mg"	$5.540
J0480	Basiliximab	"$4,422.319"
J0485	Belatacept injection	$3.671
J0490	Belimumab injection	$51.857
J0491	Inj anifrolumab-fnia 1mg	$16.771
J0517	"Inj., benralizumab, 1 mg"	$154.057
J0565	"Injection, bezlotoxumab"	$37.612
J0567	"Inj., cerliponase alfa 1 mg"	$94.380
J0578	"Inj,brixadi, more than 7 day"	"$1,605.297"
J0584	"Injection, burosumab-twza 1m"	$443.153
J0586	AbobotulinumtoxinA	$8.532
J0596	"C-1 esterase, Ruconest"	$32.783
J0597	"C-1 esterase, berinert"	$68.176
J0598	"C-1 esterase, cinryze"	$60.261
J0600	Edetate calcium disodium inj	"$6,094.364"
J0638	Canakinumab injection	$128.827
J0717	Certolizumab pegol inj 1 mg	$3.759
J0739	"Injection, cabotegravir 1 mg"	$6.497
J0741	"Inj, cabote rilpivir 2mg 3mg"	$21.823
J0775	"Collagenase, clost hist inj"	$69.222
J0791	Inj crizanlizumab-tmca 5mg	$122.172
J0850	Cytomegalovirus imm IV /vial	"$1,709.441"
J0870	"Injection, imetelstat, 1 mg"	$52.368
J0875	"Injection, dalbavancin"	$14.686
J0896	Inj luspatercept-aamt 0.25mg	$38.909
J0897	Denosumab injection	$26.235
J1203	"Inj, cipaglucosidase, 5 mg"	$84.760
J1290	Ecallantide injection	$532.680
J1302	"Inj, sutimlimab-jome, 10 mg"	$17.101
J1303	"Inj., ravulizumab-cwvz 10 mg"	$207.846
J1304	"Inj, tofersen, 1 mg"	$146.544
J1305	"Inj, evinacumab-dgnb, 5mg"	$175.760
J1306	"Injection, inclisiran, 1 mg"	$11.579
J1307	"Inj, crovalimab-akkz, 10 mg"	$520.294
J1322	"Injection, elosulfase alfa"	$277.297
J1323	"Inj, elranatamab-bcmm, 1 mg"	$172.623
J1411	"Inj, hemgenix, per tx dose"	"$3,476,666.667"
J1412	Inj roctavian ml 2x10^13vc g	"$11,328.126"
J1413	Inj delandistrogene mox rokl	"$3,134,408.769"
J1414	"Inj, beqvez, per tx dose"	"$3,500,000.000"
J1437	Inj. fe derisomaltose 10 mg	$19.647
J1438	Etanercept injection	$746.020
J1440	Fecalmicrobiota jslm 1 ml	$60.315
J1448	"Injection, trilaciclib, 1mg"	$5.083
J1449	Inj eflapegrastim-xnst 0.1mg	$21.328
J1458	Galsulfase injection	$566.740
J1459	Inj IVIG privigen 500 mg	$46.395
J1552	"Inj, alyglo, 500 mg"	$130.293
J1554	Inj. asceniv	$468.569
J1555	"Inj cuvitru, 100 mg"	$15.738
J1556	"Inj, Imm Glob Bivigam, 500mg"	$129.400
J1558	"Inj. xembify, 100 mg"	$13.475
J1559	Hizentra injection	$12.872
J1560	Gamma globulin > 10 CC inj	$461.182
J1561	Gamunex-C/Gammaked	$45.609
J1566	"Immune globulin, powder"	$76.426
J1568	Octagam injection	$45.335
J1569	Gammagard liquid injection	$42.575
J1572	Flebogamma injection	$87.160
J1573	"Hepagam b intravenous, inj"	$61.459
J1575	Hyqvia 100mg immuneglobulin	$16.571
J1576	"Inj, panzyga, 500 mg"	$66.445
J1602	Golimumab For IV	$10.159
J1628	"Inj., guselkumab, 1 mg"	$66.441
J1640	"Hemin, 1 mg"	$31.201
J1743	Idursulfase injection	$511.862
J1744	Icatibant injection	$118.224
J1745	Infliximab injection	$28.795
J1746	"Inj., ibalizumab-uiyk, 10 mg"	$72.594
J1747	"Inj, spesolimab-sbzo, 1 mg"	$57.951
J1748	"Inj, zymfentra, 10 mg"	$87.580
J1786	Imuglucerase injection	$40.699
J1823	"Inj. inebilizumab-cdon, 1 mg"	$456.984
J1826	Interferon beta-1a inj	"$2,458.570"
J1930	Lanreotide injection	$37.312
J1931	Laronidase injection	$36.420
J1932	"Inj, lanreotide, (cipla) 1mg"	$23.983
J1943	"Inj., aristada initio, 1 mg"	$2.965
J1944	aripirazole lauroxil 1 mg	$3.075
J1950	Leuprolide acetate /3.75 MG	"$1,575.751"
J1951	Inj fensolvi 0.25 mg	$126.657
J1952	"Leuprolide inj, camcevi, 1mg"	$49.413
J1961	"Inj, lenacapavir, 1 mg"	$20.783
J2182	"Injection, mepolizumab"	$28.811
J2267	"Inj, mirikizumab-mrkz, 1 mg"	$44.874
J2277	"Inj, motixafortide, 0.25 mg"	$23.791
J2315	"Naltrexone, depot form"	$3.890
J2323	Natalizumab injection	$22.989
J2326	"Injection, nusinersen"	"$1,177.925"
J2327	Inj risankizumab-rzaa1 mg	$14.018
J2329	"Inj ublituximab-xiiy, 1 mg"	$64.769
J2350	"Injection, ocrelizumab"	$54.535
J2351	Inj ocrelizumab 1mg hya-ocsq	$42.629
J2353	"Octreotide injection, depot"	$193.011
J2356	"Inj tezepelumab-ekko, 1mg"	$16.761
J2357	Omalizumab injection	$37.846
J2406	"Injection, oritavancin 10 mg"	$40.344
J2407	"Injection, oritavancin"	$26.910
J2425	Palifermin injection	$32.067
J2426	"Inj, invega sustenna, 1 mg"	$13.905
J2427	"Inj, invega hafyera/trinza"	$11.955
J2428	"Inj, erzofri, 1 mg"	$16.651
J2502	"Inj, pasireotide long acting"	$497.115
J2507	Pegloticase injection	"$3,363.508"
J2508	Pegunigalsidase alfa-iwxj	$214.082
J2724	Protein c concentrate	$14.174
J2777	"Inj, faricimab-svoa, 0.1mg"	$32.757
J2779	"Inj, susvimo 0.1 mg"	$75.224
J2781	"Inj, pegcetacoplan 1 mg"	$135.839
J2782	Inj avacincaptad pegol 0.1mg	$101.362
J2783	Rasburicase	$349.487
J2786	"Injection, reslizumab"	$9.900
J2792	"Rho(D) immune globulin h, sd"	$30.667
J2798	"Inj., perseris, 0.5 mg"	$11.466
J2799	"Inj, uzedy, 1 mg"	$23.228
J2802	"Inj, romiplostim 1 microgram"	$9.921
J2840	"Injection, sebelipase alfa"	$508.207
J2860	"Injection, siltuximab"	$154.119
J2993	Reteplase injection	"$2,619.940"
J2998	Inj plasminogen tvmh 1mg	$30.550
J3032	"Injection, eptinezumab-jjmr"	$18.227
J3055	Inj talquetamab-tgvs 0.25 mg	$66.035
J3060	"Inj, Taliglucerace Alfa 10 u"	$38.342
J3101	Tenecteplase injection	$153.260
J3111	Inj. romosozumab-aqqg 1 mg	$10.843
J3240	Thyrotropin injection	"$1,961.048"
J3241	"Injection, teprotumumab-trbw"	$332.607
J3245	"Inj., tildrakizumab, 1 mg"	$124.021
J3247	Inj secukinumab intrav 1mg	$16.725
J3262	Tocilizumab injection	$5.548
J3263	"Inj, toripalimab-tpzi, 1 mg"	$36.883
J3315	Triptorelin pamoate	$444.929
J3316	"Inj., triptorelin xr 3.75 mg"	"$3,307.586"
J3357	Ustekinumab injection	$143.761
J3358	"Ustekinumab IV Inj, 1 mg"	$12.083
J3380	Inj vedolizumab iv 1 mg	$19.964
J3385	Velaglucerase alfa	$353.170
J3392	"Inj, exagamglogene autotem"	"$2,200,000.000"
J3393	"Inj, betibeglogene autotemce"	"$2,781,333.333"
J3394	"Inj, lovotibeglogene autotem"	"$3,100,000.000"
J3396	Verteporfin injection	$10.867
J3398	Inj luxturna 1 billion vec g	"$2,968.168"
J3399	Inj onase abepar-xioi treat	"$2,285,972.859"
J3401	"Vyjuvek 5x10^9pfu/ml, 0.1 ml"	$959.122
J7165	"Inj, human-lans, per i.u"	$1.459
J7168	Prothrombin complex kcentra	$2.053
J7169	"Inj andexxa, 10 mg"	$124.281
J7170	"Inj., emicizumab-kxwh 0.5 mg"	$49.056
J7171	"Inj, adzynma, 10 iu"	$32.562
J7175	"Inj, factor x, (human), 1iu"	$9.008
J7177	"Inj., fibryga, 1 mg"	$1.053
J7178	Inj human fibrinogen conc inj nos	$1.415
J7179	Vonvendi inj 1 iu vwf:rco	$1.742
J7180	Factor XIII anti-hem factor	$9.899
J7182	Factor VIII recomb novoeight	$1.333
J7183	Wilate injection	$1.221
J7185	Xyntha inj	$1.420
J7186	Antihemophilic viii/vwf comp	$1.145
J7187	"Humate-P, inj"	$1.379
J7188	Factor VIII recomb obizur	$3.061
J7189	Factor viia recomb novoseven	$2.398
J7190	Factor viii	$1.067
J7192	Factor viii recombinant NOS	$1.484
J7193	Factor IX non-recombinant	$1.314
J7194	Factor ix complex	$1.577
J7195	Factor ix recombinant NOS	$1.758
J7197	Antithrombin iii injection	$3.720
J7198	Anti-inhibitor	$2.276
J7200	Factor IX recombinant	$0.850
J7201	Factor ix (Alprolix)	$3.359
J7202	"Idelvion, 1 i.u."	$4.904
J7203	Factor ix recomb gly rebinyn	$4.090
J7204	Inj recombin esperoct per iu	$2.032
J7205	Factor VIII (Eloctate)	$2.203
J7207	Adynovate Factor VIII recom	$1.998
J7208	Factor viii pegylated-aucl	$2.326
J7209	Nuwiq Factor VIII recomb	$1.140
J7210	"Inj, afstyla, 1 i.u."	$1.443
J7211	"Inj, kovaltry 1 i.u."	$1.417
J7212	Factor viia recomb sevenfact	$1.990
J7213	"Inj, ixinity, 1 i.u."	$1.829
J7214	Altuviiio per factor viii iu	$4.351
J7311	"Inj., retisert, 0.01 mg"	$320.789
J7312	Dexamethasone intra implant	$193.619
J7313	"Inj., iluvien, 0.01 mg"	$462.986
J7314	"Inj., yutiq, 0.01 mg"	$494.876
J7336	Capsaicin 8% patch	$3.186
J7351	Inj bimatoprost itc imp 1mcg	$198.026
J7352	"Afamelanotide implant, 1 mg"	"$2,710.688"
J7353	Anacaulase-bcdb 8.8% gel 1 g	$55.006
J7354	"Cantharidin top, applicator"	$643.639
J7355	Inj travoprost intra impl	$183.407
J7504	Lymphocyte immune globulin	"$4,128.576"
J7511	Antithymocyte globuln rabbit	$886.176
J8705	Topotecan oral	$333.990
J9015	Aldesleukin injection	"$3,559.740"
J9021	"Inj, aspara, rylaze, 0.1 mg"	$51.300
J9022	"Injection, atezolizumab"	$84.334
J9023	"Injection, avelumab"	$91.639
J9024	Inj atezolizumb 5mg hya-tqjs	$29.128
J9026	"Inj, tarlatamab-dlle, 1 mg"	"$1,481.854"
J9028	"Inj, nogapendekin pmln, 1mcg"	$89.227
J9029	"Instill adstiladrin, tx dose"	"$59,656.233"
J9032	"Injection, belinostat"	$48.037
J9034	"Inj., Bendeka 1 mg"	$12.812
J9035	Bevacizumab injection	$68.611
J9036	"Inj., belrapzo 1 mg"	$13.393
J9038	Inj axatilimab-csfr 0.1 mg	$52.500
J9039	"Inj, blinatumomab"	$143.657
J9042	Brentuximab vedotin inj	$234.840
J9043	Cabazitaxel injection	$209.156
J9047	"Injection, carfilzomib, 1 mg"	$48.912
J9055	Cetuximab injection	$73.136
J9056	"Inj, vivimusta, 1 mg"	$25.701
J9057	"Inj., copanlisib, 1 mg"	$84.117
J9061	"Inj, amivantamab-vmjw"	$20.290
J9063	"Inj, mirvetuximab-gynx, 1 mg"	$64.221
J9064	"Inj, cabazitaxel (sandoz)"	$144.860
J9072	Inj cyclophos avyxa 5mg	$8.541
J9119	"Inj., cemiplimab-rwlc, 1 mg"	$27.284
J9144	"Daratumumab, hyaluronidase"	$49.993
J9145	"Injection, daratumumab"	$63.797
J9153	"Inj daunorubicin, cytarabine"	$234.926
J9172	"Docetaxel (avyxa), 1 mg"	$48.698
J9173	"Inj., durvalumab, 10 mg"	$79.121
J9176	"Injection, elotuzumab"	$7.294
J9177	Inj enfort vedo-ejfv 0.25mg	$34.568
J9179	Eribulin mesylate injection	$112.027
J9200	Floxuridine injection	"$3,762.578"
J9203	Gemtuzumab ozogamicin 0.1 mg	$219.924
J9204	"Inj, mogamulizumab-kpkc, 1 mg"	$229.835
J9205	"Inj, irinotecan liposome"	$61.583
J9207	Ixabepilone injection	$128.497
J9210	"Inj., emapalumab-lzsg, 1 mg"	$359.909
J9216	Interferon gamma 1-b inj	"$6,241.680"
J9223	"Inj. lurbinectedin, 0.1 mg"	$193.430
J9226	Supprelin LA implant	"$42,652.868"
J9227	Inj. isatuximab-irfc 10 mg	$74.392
J9228	Ipilimumab injection	$170.014
J9229	Inj inotuzumab ozogam 0.1 mg	"$2,507.669"
J9246	"Inj., evomela, 1 mg"	$17.451
J9261	Nelarabine injection	$59.608
J9262	"Inj, omacetaxine mep, 0.01mg"	$4.270
J9264	Paclitaxel protein bound	$12.325
J9266	Pegaspargase injection	"$25,538.240"
J9268	Pentostatin injection	"$2,522.105"
J9269	Inj. tagraxofusp-erzs 10 mcg	$319.370
J9271	"Injection, pembrolizumab"	$55.990
J9272	"Inj, dostarlimab-gxly, 10 mg"	$226.543
J9273	"Inj tisotu vedotin-tftv, 1mg"	$177.973
J9274	"Inj, tebentafusp-tebn, 1 mcg"	$202.600
J9281	Mitomycin instillation	$295.278
J9286	"Inj glofitamab gxbm, 2.5 mg"	"$2,615.847"
J9292	"Inj, pemetrexed dipotassium"	$79.000
J9295	"Injection, necitumumab"	$5.407
J9298	Inj nivol relatlimab 3mg/1mg	$183.092
J9299	"Injection, nivolumab"	$30.521
J9301	"Injection, obinutuzumab"	$70.955
J9302	Ofatumumab injection	$58.711
J9303	Panitumumab injection	$155.588
J9304	"Inj. pemetrexed, 10 mg"	$43.726
J9306	"Injection, Pertuzumab, 1 mg"	$15.310
J9307	Pralatrexate injection	$352.611
J9308	"Injection, ramucirumab"	$69.215
J9309	"Inj, polatuzumab vedotin 1mg"	$125.212
J9311	"Inj rituximab, hyaluronidase"	$35.402
J9312	"lnj., rituximab, 10 mg"	$72.107
J9313	"Inj., lumoxiti, 0.01 mg"	$22.070
J9316	"Pertuzu, trastuzu, 10 mg"	$59.427
J9317	Sacituzumab govitecan-hziy	$33.774
J9318	Inj romidepsin non-lyo 0.1mg	$26.903
J9319	Inj romidepsin lyophil 0.1mg	$29.756
J9321	"Inj epcoritamab-bysp, 0.1 mg"	$51.756
J9324	"Inj, pemrydi rtu, 10 mg"	$76.469
J9325	Inj talimogene laherparepvec	$66.393
J9328	Temozolomide injection	$9.817
J9329	"Inj, tislelizumab-jsgr"	$546.400
J9331	Inj sirolimus prot part 1 mg	$110.974
J9332	Inj efgartigimod 2mg	$30.543
J9333	Inj ronzanolixizum-noli 1 mg	$21.549
J9334	Inj efgart-alfa 2mg hya-qvfc	$31.482
J9345	"Inj, retifanlimab-dlwr, 1 mg"	$28.053
J9347	"Inj, tremelimumab-actl, 1 mg"	$130.419
J9348	"Inj. naxitamab-gqgk, 1 mg"	$605.499
J9349	"Injection, tafasitamab-cxix, 2 mg"	$13.137
J9350	"Inj mosunetuzumab-axgb, 1 mg"	$604.676
J9352	"Injection, trabectedin"	$343.238
J9353	"Inj. margetuximab-cmkb, 5 mg"	$45.783
J9354	"Inj, Ado-trastuzumab Emt 1mg"	$38.778
J9355	Inj trastuzumab excl biosimi	$71.408
J9356	"Inj. herceptin hylecta, 10mg"	$59.355
J9357	Valrubicin injection	"$1,362.783"
J9358	Inj fam-trastu deru-nxki 1mg	$27.265
J9359	Inj lon tesirin-lpyl 0.075mg	$199.995
J9380	"Inj, teclistamab-cqyv, 0.5mg"	$30.584
J9381	"Inj, teplizumab-mzwv, 4 mcg"	$35.195
J9400	"Inj, ziv-aflibercept, 1mg"	$7.828
Q2041	Axicabtagene ciloleucel car+	"$474,378.045"
Q2042	Tisagenlecleucel car-pos t	"$546,010.493"
Q2053	Brexucabtagene car pos t	"$461,697.318"
Q2054	lisocabtagene car pos t	"$487,209.703"
Q2055	Idecabtagene car pos t	"$497,757.040"
Q2056	Ciltacabtagene car-pos t	"$521,857.829"
Q2057	Afamitresgene autoleucel	"$727,000.000"
Q5107	Inj mvasi 10 mg	$24.335
Q5111	"Injection, udenyca 0.5 mg"	$162.473
Q5113	Inj herzuma 10 mg	$68.192
Q5114	Inj  ogivri 10 mg	$41.103
Q5115	Inj rituximab-abbs bio 10 mg	$28.991
Q5118	"Inj., zirabev, 10 mg"	$21.454
Q5119	"Inj ruxience, 10 mg"	$19.175
Q5122	"Inj, nyvepria"	$133.121
Q5123	"Inj. riabni, 10 mg"	$27.319
Q5126	"Inj, alymsys, 10 mg"	$40.565
Q5127	"Inj, stimufend, 0.5 mg"	$250.114
Q5129	"Inj, vegzelma, 10 mg"	$42.591
Q5130	"Inj, fylnetra, 0.5 mg"	$163.023
Q5133	"Inj, tofidence, 1 mg"	$5.527
Q5136	"Inj. denosumab-bbdz, 1 mg"	$26.736
Q5140	"Inj adalimumab-fkjp, 1 mg"	$82.206
Q5141	"Inj adalimumab-aaty, 1 mg"	$41.103
Q5145	"Inj, abrilada, 1 mg"	$71.171
Q5146	"Inj, hercessi, 10 mg"	$71.869
Q5147	"Inj, aflibercept-ayyh, 1 mg"	$750.812
Q5151	"Inj, eculizumab-aagh, 2 mg"	$30.440
Q5152	"Inj, eculizumab-aeeb, 2 mg"	$39.138
Q9982	Flutemetamol F18	"$1,962.950"
Q9983	Florbetaben F18	"$1,577.130"
Q9991	Buprenorph xr 100 mg or less	"$1,816.256"
Q9992	Buprenorphine xr over 100 mg	"$1,816.256"
Q9998	"Inj ustekinumab-aekn, 1 mg"	$46.405
