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Drug Trend · Gastroenterology
Every Medicare Part B payment limit CMS has published for J3380 — 43 quarters since Q1 2016, about 11 years of pricing on one axis. Public CMS data with our change framing; no contracted rates.
A GI infusion staple with no biosimilar and a payment limit that has climbed steadily since 2016. The structural event ahead is statutory, not competitive: vedolizumab is on the IRA's IPAY-2028 selected list, so a negotiated Maximum Fair Price reshapes this line in 2028.
CMS payment limit (ASP + 6% basis) by quarter, as published.
At the Q3 2026 limit of $21.622 per 1 mg, the implied ASP is about $20.398 and the on-paper add-on is $1.224 per 1 mg. After the 2% sequester on Medicare’s 80% share, the effective add-on is roughly 4.3% of ASP — about $0.877 per 1 mgwhen 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. Crohn's/UC: 300 mg IV at weeks 0, 2, 6, then every 8 weeks — 300 billing units per dose (1 mg/unit). At the Q3 2026 limit of $21.622 per 1 mg, a typical 300-unit dose carries a Medicare allowable of about $6,486.60 — Medicare pays ~$5,085.494 after the sequester, and ~$1,297.32 rides on coinsurance collection. Part B spent $727.8 million on J3380 in 2023 across 18,640 beneficiaries (CMS Part B drug-spending data).
Administration. 96365 (+96366 per additional hour) — therapeutic IV infusion over ~30 minutes.
Waste modifiers. Single-dose container — JW (documented discard) / JZ (no waste) modifiers required since July 2023. Run your own numbers on the buy-and-bill calculator.
The coding & patient-cost side. This page covers the provider-margin story; for Entyvio’s full billing reference — dosing conversions, modifiers, admin CPT detail, payer policies, and what the patient owes — see Entyvio on CareCost Estimate, our billing-reference sister site.
Where J3380stands in the national payers’ published sourcing programs (the office-vs-hospital setting distinction most coverage misses):
State law is the other half: the white-bagging laws-by-state tracker — 11 states currently ban payer sourcing mandates outright.
All 43 published quarters for J3380, newest first, as published per file version.
| Quarter | Limit ($/1 mg) | QoQ |
|---|---|---|
| Q3 2026 | 21.622 | +3.1% |
| Q2 2026 | 20.98 | -1.8% |
| Q1 2026 | 21.371 | +0.3% |
| Q4 2025 | 21.311 | -3.4% |
| Q3 2025 | 22.062 | +4.3% |
| Q2 2025 | 21.162 | -2.3% |
| Q1 2025 | 21.67 | -2.7% |
| Q4 2024 | 22.26 | -2.7% |
| Q3 2024 | 22.877 | +4.7% |
| Q2 2024 | 21.853 | -1.0% |
| Q1 2024 | 22.063 | -1.0% |
| Q4 2023 | 22.296 | -1.7% |
| Q3 2023 | 22.677 | +3.8% |
| Q2 2023 | 21.84 | +0.7% |
| Q1 2023 | 21.695 | -2.7% |
| Q4 2022 | 22.297 | -2.0% |
| Q3 2022 | 22.757 | +4.8% |
| Q2 2022 | 21.72 | +2.0% |
| Q1 2022 | 21.293 | +0.1% |
| Q4 2021 | 21.279 | +1.3% |
| Q3 2021 | 21.015 | +1.7% |
| Q2 2021 | 20.666 | +1.6% |
| Q1 2021 | 20.348 | +0.3% |
| Q4 2020 | 20.297 | -1.7% |
| Q3 2020 | 20.658 | +2.4% |
| Q2 2020 | 20.165 | -0.4% |
| Q1 2020 | 20.242 | +1.9% |
| Q4 2019 | 19.864 | -1.3% |
| Q3 2019 | 20.131 | +2.0% |
| Q2 2019 | 19.743 | -1.5% |
| Q1 2019 | 20.04 | +2.3% |
| Q4 2018 | 19.581 | -0.2% |
| Q3 2018 | 19.622 | +2.6% |
| Q2 2018 | 19.13 | +3.1% |
| Q1 2018 | 18.559 | -0.2% |
| Q4 2017 | 18.59 | +2.9% |
| Q3 2017 | 18.062 | -0.4% |
| Q2 2017 | 18.127 | +3.1% |
| Q1 2017 | 17.579 | +0.8% |
| Q4 2016 | 17.431 | +2.4% |
| Q3 2016 | 17.027 | +0.0% |
| Q2 2016 | 17.027 | +0.0% |
| Q1 2016 | 17.027 | — |
Entyvio (vedolizumab) is billed to Medicare Part B under HCPCS code J3380, with a billing unit of 1 mg. Total billed units depend on the administered dose.
Crohn's/UC: 300 mg IV at weeks 0, 2, 6, then every 8 weeks — 300 billing units per dose (1 mg/unit). Administration is billed separately: 96365 (+96366 per additional hour) — therapeutic IV infusion over ~30 minutes.
At the Q3 2026 limit, a typical 300-unit dose carries an allowable of about $6,486.60. Medicare pays roughly $5,085.494 (80% less the 2% sequester) and the remaining ~$1,297.32 is patient or secondary coinsurance the practice still has to collect — before any administration revenue.
Yes. Entyvio 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.
$21.622 per 1 mg, effective July 1, 2026, per the CMS July 2026 ASP pricing file. That is up 3.1% from the prior quarter and down 2.0% year over year.
The archive holds 43 quarters for J3380, starting at $17.027 per 1 mg in Q1 2016. The all-time peak was $22.877 in Q3 2024; the current limit is $21.622.
The payment limit is set at ASP + 6% (currently implying an ASP of about $20.398 per 1 mg). After the 2% sequester on Medicare's 80% share, the effective add-on is roughly 4.3% — about $0.877 per 1 mg — when the full allowable is collected.
Yes — vedolizumab 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/entyvio-j3380-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 J3380 against your acquisition cost, payer mix, and 835s — and prices the answer in dollars.