HCPCS J3420 Medicare ASP Payment Limit 2026
Injection, vitamin B-12 cyanocobalamin, up to 1000 mcg
Medicare's Part B payment limit for HCPCS J3420 is $0.648 per billing unit (up to 1000 mcg) in the October 2026 ASP file, down 35.5% from $1.01 in 2025.
- Per up to 1000 mcg
- $0.648
- vs. 2025
- -35.5%
- Commercial national avg.
- $1.47
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| Code | Month | Year | Payment Limit | Description |
|---|---|---|---|---|
| J3420 - HCPCS | Jan | 2025 | $1.27 | Injection, vitamin B-12 cyanocobalamin, up to 1000 mcg |
| J3420 - HCPCS | Apr | 2025 | $0.67 | Injection, vitamin B-12 cyanocobalamin, up to 1000 mcg |
| J3420 - HCPCS | Jul | 2025 | $0.95 | Injection, vitamin B-12 cyanocobalamin, up to 1000 mcg |
| J3420 - HCPCS | Oct | 2025 | $1.01 | Injection, vitamin B-12 cyanocobalamin, up to 1000 mcg |
| J3420 - HCPCS | Jan | 2026 | $0.64 | Injection, vitamin B-12 cyanocobalamin, up to 1000 mcg |
| J3420 - HCPCS | Apr | 2026 | $0.67 | Injection, vitamin B-12 cyanocobalamin, up to 1000 mcg |
| J3420 - HCPCS | Jul | 2026 | $0.68 | Injection, vitamin B-12 cyanocobalamin, up to 1000 mcg |
| J3420 - HCPCS | Oct | 2026 | $0.65 | Injection, vitamin B-12 cyanocobalamin, up to 1000 mcg |
J3420 payment limit by quarter
Each row is one quarterly CMS ASP file. Change is against the quarter before.
| Quarter | Payment limit per up to 1000 mcg | Change |
|---|---|---|
| October 2026 | $0.648 | -5.1% |
| July 2026 | $0.683 | +2.4% |
| April 2026 | $0.667 | +4.5% |
| January 2026 | $0.638 | -36.5% |
| October 2025 | $1.01 | +6.1% |
| July 2025 | $0.947 | +42.4% |
| April 2025 | $0.665 | -47.7% |
| January 2025 | $1.27 | - |
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.
J3420: Medicare vs. commercial national average
The commercial national average for J3420, the mean of what BCBS, UnitedHealthcare, Aetna and Cigna publish nationwide, is $1.47 per up to 1000 mcg, 227% of Medicare's $0.648.
- BCBS $1.67
- UnitedHealthcare $1.31
- Aetna $1.62
- Cigna $1.29
A national average, not a local rate: each payer's figure averages the unmodified, in-network professional rates it publishes for J3420 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 J3420 with published commercial rates
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See what state Medicaid programs pay for J3420
50 state Medicaid agencies publish their own physician fee schedule. The J3420 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