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Drug Trend · Neurology · Urology · PM&R
Every Medicare Part B payment limit CMS has published for J0585 — 87 quarters since Q1 2005, about 22 years of pricing on one axis, with the competing products alongside. Public CMS data with our change framing; no contracted rates.
Twenty-one years of unusually quiet pricing — Botox's per-unit limit moved from $4.71 to $6.51 since 2005, with four competing toxins (each its own code, none interchangeable) pricing around it. Like Entyvio, the disruption ahead is the IRA: onabotulinumtoxinA is IPAY-2028 selected.
CMS payment limit (ASP + 6% basis) by quarter, as published.
Every code carries its own payment limit — same-molecule economics can differ by 50%+ between products.
| HCPCS | Product | In file since | Current limit | vs J0585 |
|---|---|---|---|---|
| J0586 | Dysport (abobotulinumtoxinA) | Q1 2010 | $8.946 | 38% |
| J0587 | Myobloc (rimabotulinumtoxinB) | Q1 2005 | $13.287 | 104% |
| J0588 | Xeomin (incobotulinumtoxinA) | Q1 2012 | $5.285 | -19% |
| J0589 | Daxxify (daxibotulinumtoxinA) | Q2 2025 | $3.067 | -53% |
At the Q3 2026 limit of $6.506 per 1 unit, the implied ASP is about $6.138 and the on-paper add-on is $0.368 per 1 unit. After the 2% sequester on Medicare’s 80% share, the effective add-on is roughly 4.3% of ASP — about $0.264 per 1 unitwhen the full allowable is collected. Whether that covers your carrying cost, waste, and denials depends on your acquisition price against ASP — which is exactly the number the payment limit can’t see, and the comparison the practice X-Ray runs with your actuals.
Dose math. Chronic migraine: 155 units total (5 units × 31 sites) every 12 weeks = 155 billing units (1 unit/unit); OAB is 100 units. At the Q3 2026 limit of $6.506 per 1 unit, a typical 155-unit dose carries a Medicare allowable of about $1,008.43 — Medicare pays ~$790.609 after the sequester, and ~$201.686 rides on coinsurance collection. Part B spent $444.5 million on J0585 in 2023 across 156,945 beneficiaries (CMS Part B drug-spending data).
Administration. 64615 — chemodenervation for chronic migraine, bilateral (CMS billing article A57185); other indications use 64612/64616/52287.
Waste modifiers. Single-dose container — JW (documented discard) / JZ (no waste) modifiers required since July 2023. Run your own numbers on the buy-and-bill calculator.
The coding & patient-cost side. For billing references across 370+ drugs (dosing conversions, modifiers, payer policies, patient cost), see CareCost Estimate’s drug library, our billing-reference sister site.
Where J0585stands in the national payers’ published sourcing programs (the office-vs-hospital setting distinction most coverage misses):
State law is the other half: the white-bagging laws-by-state tracker — 11 states currently ban payer sourcing mandates outright.
All 87 published quarters for J0585, newest first, as published per file version.
| Quarter | Limit ($/1 unit) | QoQ |
|---|---|---|
| Q3 2026 | 6.506 | -0.1% |
| Q2 2026 | 6.512 | +0.0% |
| Q1 2026 | 6.51 | +0.2% |
| Q4 2025 | 6.497 | -0.1% |
| Q3 2025 | 6.502 | +0.4% |
| Q2 2025 | 6.478 | +0.1% |
| Q1 2025 | 6.471 | +1.0% |
| Q4 2024 | 6.406 | +0.5% |
| Q3 2024 | 6.375 | +0.9% |
| Q2 2024 | 6.319 | -0.1% |
| Q1 2024 | 6.327 | +0.0% |
| Q4 2023 | 6.325 | -0.4% |
| Q3 2023 | 6.352 | +0.5% |
| Q2 2023 | 6.318 | -0.0% |
| Q1 2023 | 6.319 | +1.4% |
| Q4 2022 | 6.229 | +0.4% |
| Q3 2022 | 6.207 | +0.4% |
| Q2 2022 | 6.185 | +0.2% |
| Q1 2022 | 6.171 | +1.4% |
| Q4 2021 | 6.085 | +0.1% |
| Q3 2021 | 6.076 | +0.3% |
| Q2 2021 | 6.059 | -0.1% |
| Q1 2021 | 6.063 | -0.2% |
| Q4 2020 | 6.077 | -0.3% |
| Q3 2020 | 6.095 | -0.2% |
| Q2 2020 | 6.11 | -0.2% |
| Q1 2020 | 6.122 | -0.0% |
| Q4 2019 | 6.123 | -0.0% |
| Q3 2019 | 6.124 | +0.1% |
| Q2 2019 | 6.119 | -0.3% |
| Q1 2019 | 6.137 | -0.0% |
| Q4 2018 | 6.138 | -0.3% |
| Q3 2018 | 6.158 | +0.2% |
| Q2 2018 | 6.147 | +0.4% |
| Q1 2018 | 6.125 | +1.6% |
| Q4 2017 | 6.031 | +0.7% |
| Q3 2017 | 5.988 | +0.8% |
| Q2 2017 | 5.941 | -0.0% |
| Q1 2017 | 5.942 | +0.2% |
| Q4 2016 | 5.93 | +1.6% |
| Q3 2016 | 5.837 | +2.1% |
| Q2 2016 | 5.717 | -0.1% |
| Q1 2016 | 5.721 | +0.1% |
| Q4 2015 | 5.717 | -0.2% |
| Q3 2015 | 5.726 | +2.8% |
| Q2 2015 | 5.571 | -0.1% |
| Q1 2015 | 5.576 | +0.3% |
| Q4 2014 | 5.56 | -0.1% |
| Q3 2014 | 5.566 | +2.6% |
| Q2 2014 | 5.425 | -0.3% |
| Q1 2014 | 5.442 | -0.2% |
| Q4 2013 | 5.453 | -0.2% |
| Q3 2013 | 5.466 | +0.0% |
| Q2 2013 | 5.464 | -0.1% |
| Q1 2013 | 5.47 | -0.0% |
| Q4 2012 | 5.471 | -0.1% |
| Q3 2012 | 5.475 | -0.0% |
| Q2 2012 | 5.477 | -0.1% |
| Q1 2012 | 5.482 | +0.0% |
| Q4 2011 | 5.481 | -0.1% |
| Q3 2011 | 5.485 | +0.1% |
| Q2 2011 | 5.477 | -0.1% |
| Q1 2011 | 5.48 | -0.1% |
| Q4 2010 | 5.487 | -0.1% |
| Q3 2010 | 5.492 | -0.1% |
| Q2 2010 | 5.495 | -0.1% |
| Q1 2010 | 5.503 | -0.1% |
| Q4 2009 | 5.506 | -0.1% |
| Q3 2009 | 5.513 | -0.1% |
| Q2 2009 | 5.518 | +0.8% |
| Q1 2009 | 5.473 | +1.4% |
| Q4 2008 | 5.397 | +0.2% |
| Q3 2008 | 5.386 | +3.2% |
| Q2 2008 | 5.219 | -0.7% |
| Q1 2008 | 5.256 | -0.0% |
| Q4 2007 | 5.258 | -0.1% |
| Q3 2007 | 5.263 | +3.2% |
| Q2 2007 | 5.102 | +0.1% |
| Q1 2007 | 5.095 | +1.2% |
| Q4 2006 | 5.035 | +0.1% |
| Q3 2006 | 5.029 | +2.6% |
| Q2 2006 | 4.901 | -0.1% |
| Q1 2006 | 4.906 | -0.0% |
| Q4 2005 | 4.908 | +0.4% |
| Q3 2005 | 4.89 | +3.8% |
| Q2 2005 | 4.709 | -0.1% |
| Q1 2005 | 4.714 | — |
Botox (onabotulinumtoxinA) is billed to Medicare Part B under HCPCS code J0585, with a billing unit of 1 unit. Total billed units depend on the administered dose.
Chronic migraine: 155 units total (5 units × 31 sites) every 12 weeks = 155 billing units (1 unit/unit); OAB is 100 units. Administration is billed separately: 64615 — chemodenervation for chronic migraine, bilateral (CMS billing article A57185); other indications use 64612/64616/52287.
At the Q3 2026 limit, a typical 155-unit dose carries an allowable of about $1,008.43. Medicare pays roughly $790.609 (80% less the 2% sequester) and the remaining ~$201.686 is patient or secondary coinsurance the practice still has to collect — before any administration revenue.
Yes. Botox ships in single-dose containers, so since July 2023 CMS requires the JW modifier for documented discarded amounts and the JZ modifier when there is no waste. Missing modifiers are a common audit and denial trigger on this code.
$6.506 per 1 unit, effective July 1, 2026, per the CMS July 2026 ASP pricing file. That is down 0.1% from the prior quarter and up 0.1% year over year.
The archive holds 87 quarters for J0585, starting at $4.714 per 1 unit in Q1 2005. The all-time peak was $6.512 in Q2 2026; the current limit is $6.506.
The payment limit is set at ASP + 6% (currently implying an ASP of about $6.138 per 1 unit). After the 2% sequester on Medicare's 80% share, the effective add-on is roughly 4.3% — about $0.264 per 1 unit — when the full allowable is collected.
Yes — onabotulinumtoxinA is on the IRA's IPAY-2028 selected-drug list, one of the five Part B drugs in the first negotiation cycle ever to reach physician-administered drugs. CMS announces the negotiated Maximum Fair Price by November 30, 2026, and from January 1, 2028 the payment limit becomes 106% of MFP, replacing the ASP+6% basis for this drug.
Which limits moved this quarter, across all drugs: the ASP-change leaderboard. How this data is built and verified: the Data Desk. Billing reference (dosing, modifiers, admin CPTs): CareCost Estimate’s drug library.
carecostoptimizer.com/drugs/botox-j0585-asp-trend. Computed from the public-domain CMS ASP pricing files. Free to cite with attribution.Drug economics as of Q3 2026 (Medicare ASP basis)
The chart is the national price. The practice X-Ray runs J0585 against your acquisition cost, payer mix, and 835s — and prices the answer in dollars.