HCPCS Level IIStatus E

HCPCS Code J1000

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Source: CMS 2026 ASP Pricing FileEffective Reviewed by the D3rx Clinical Billing Team

2026 ASP pricing

ASP payment limit

$49.28

Per billing unit (5 MG) · 2026 Q1

HCPCS J1000 is not priced under the Physician Fee Schedule (status E). Drugs and biologicals are reimbursed at 106% of the Average Sales Price (ASP), not under the RVU-based Physician Fee Schedule. The amount above is the published payment limit; actual payment is the lower of the billed charge or this limit, and may differ by quarter.

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Medical billing disclaimer

Rates shown are 2026 ASP Pricing File amounts and are for educational reference. Commercial payers, locality, and plan rules vary. Always verify current rates and coverage with the payer before billing. D3rx is not responsible for claim outcomes.