Medicare Part B Drug Payment Limit File Page
CMS may not publish a payment limit or crosswalk for all drugs that are reported by manufacturers. The absence or presence of a HCPCS, NDC code, and/or the payment limits in the Medicare Part B Payment Limit File does not indicate whether Medicare covers a particular product. Even if a product does not appear on a quarter’s Payment Limit File, the local Medicare Administrative Contractor (MAC) may process the Part B claim after determining the payment limit, provided that the claim is reasonable and necessary and meets all necessary requirements for payment. For additional information about the payment limit for new drugs and biological products during the initial period of marketing, refer to regulations at 42 CFR § 414.904(e)(4) and rulemaking in the CY 2019 PFS final rule (83 FR 59661 through 59666) and the CY 2024 PFS final rule (88 FR 79040 through 79042).
The quarterly Medicare Part B Payment Limit Files are grouped by the year in which they are effective. For more information on how ASP is reported, and what drugs and biologicals are included in the Payment Limit Files, visit the ASP Reporting page.
The quarterly ASP Pricing Files are grouped by the year in which they are effective. For more information on how ASP is reported, and what drugs and biologicals are included in the ASP Pricing Files, visit the ASP Reporting page: