HCPCS J0696 Medicare ASP Payment Limit 2026
Injection, ceftriaxone sodium, per 250 mg
Medicare's Part B payment limit for HCPCS J0696 is $0.390 per billing unit (250 mg) in the October 2026 ASP file, down 9.3% from $0.430 in 2025.
- Per 250 mg
- $0.390
- vs. 2025
- -9.3%
- Commercial national avg.
- $0.840
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| Code | Month | Year | Payment Limit | Description |
|---|---|---|---|---|
| J0696 - HCPCS | Jan | 2025 | $0.45 | Injection, ceftriaxone sodium, per 250 mg |
| J0696 - HCPCS | Apr | 2025 | $0.49 | Injection, ceftriaxone sodium, per 250 mg |
| J0696 - HCPCS | Jul | 2025 | $0.48 | Injection, ceftriaxone sodium, per 250 mg |
| J0696 - HCPCS | Oct | 2025 | $0.43 | Injection, ceftriaxone sodium, per 250 mg |
| J0696 - HCPCS | Jan | 2026 | $0.46 | Injection, ceftriaxone sodium, per 250 mg |
| J0696 - HCPCS | Apr | 2026 | $0.43 | Injection, ceftriaxone sodium, per 250 mg |
| J0696 - HCPCS | Jul | 2026 | $0.40 | Injection, ceftriaxone sodium, per 250 mg |
| J0696 - HCPCS | Oct | 2026 | $0.39 | Injection, ceftriaxone sodium, per 250 mg |
J0696 payment limit by quarter
Each row is one quarterly CMS ASP file. Change is against the quarter before.
| Quarter | Payment limit per 250 mg | Change |
|---|---|---|
| October 2026 | $0.390 | -3.5% |
| July 2026 | $0.404 | -6.0% |
| April 2026 | $0.430 | -6.9% |
| January 2026 | $0.462 | +7.4% |
| October 2025 | $0.430 | -10.6% |
| July 2025 | $0.481 | -2.4% |
| April 2025 | $0.493 | +10.5% |
| January 2025 | $0.446 | - |
The payment limit is Medicare's allowed amount per billing unit: the average sales price plus the statutory add-on. Medicare generally pays 80% of it after the Part B deductible, and the patient's coinsurance covers the rest. CMS recalculates it every quarter from manufacturer-reported sales.
J0696: Medicare vs. commercial national average
The commercial national average for J0696, the mean of what BCBS, UnitedHealthcare, Aetna and Cigna publish nationwide, is $0.840 per 250 mg, 215% of Medicare's $0.390.
- BCBS $0.862
- UnitedHealthcare $1.03
- Aetna $0.883
- Cigna $0.581
A national average, not a local rate: each payer's figure averages the unmodified, in-network professional rates it publishes for J0696 across the country in its transparency files. Contracted rates vary widely by market, provider and plan. Medicare's figure is its current ASP payment limit per billing unit. Payers may bill the drug in a different unit, so compare the two with care.
Compare Medicare's rate for J0696 with published commercial rates
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See what state Medicaid programs pay for J0696
50 state Medicaid agencies publish their own physician fee schedule. The J0696 page shows real published rates for several of them free, with effective dates and official sources.
17,674 codes and 974,327 published rates, taken from the files the state agencies publish themselves.
Methodology
Rates are sourced from CMS Part B Drug Average Sales Price (ASP) pricing files, published quarterly. Each HCPCS payment limit reflects the calculated ASP plus the statutory add-on for that quarter.
View CMS Part B ASP Pricing Files