Loading…
Drug Trend · Oncology
Every Medicare Part B payment limit CMS has published for J9271 — 43 quarters since Q1 2016, about 11 years of pricing on one axis, with the formulations alongside. Public CMS data with our change framing; no contracted rates.
The largest dollar franchise in Medicare Part B. Unusually for this list, its payment limit has risen over the decade — and the 2026 subcutaneous formulation (its own J-code, at a different per-mg limit) is the first structural fork in the franchise's pricing.
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 J9271 |
|---|---|---|---|---|
| J9277 | Keytruda Qlex SC (berahyaluronidase) | Q2 2026 | $31.94 | -47% |
At the Q3 2026 limit of $60.645 per 1 mg, the implied ASP is about $57.212 and the on-paper add-on is $3.433 per 1 mg. After the 2% sequester on Medicare’s 80% share, the effective add-on is roughly 4.3% of ASP — about $2.46 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. Most solid-tumor indications: 200 mg every 3 weeks (or 400 mg q6wk) — 200 (or 400) billing units per dose (1 mg/unit). At the Q3 2026 limit of $60.645 per 1 mg, a typical 200-unit dose carries a Medicare allowable of about $12,129.00 — Medicare pays ~$9,509.136 after the sequester, and ~$2,425.80 rides on coinsurance collection. Part B spent $5.43 billion on J9271 in 2023 across 71,411 beneficiaries (CMS Part B drug-spending data).
Administration. 96413 (+96415 per additional hour) — chemotherapy/complex-drug IV infusion over 30 minutes.
Waste modifiers. Single-dose container — JW (documented discard) / JZ (no waste) modifiers required since July 2023. Run your own numbers on the buy-and-bill calculator.
The coding & patient-cost side. This page covers the provider-margin story; for Keytruda’s full billing reference — dosing conversions, modifiers, admin CPT detail, payer policies, and what the patient owes — see Keytruda on CareCost Estimate, our billing-reference sister site.
Where J9271stands in the national payers’ published sourcing programs (the office-vs-hospital setting distinction most coverage misses):
State law is the other half: the white-bagging laws-by-state tracker — 11 states currently ban payer sourcing mandates outright.
All 43 published quarters for J9271, newest first, as published per file version.
| Quarter | Limit ($/1 mg) | QoQ |
|---|---|---|
| Q3 2026 | 60.645 | -1.0% |
| Q2 2026 | 61.251 | +2.6% |
| Q1 2026 | 59.726 | -0.9% |
| Q4 2025 | 60.291 | +3.0% |
| Q3 2025 | 58.562 | -1.3% |
| Q2 2025 | 59.349 | +3.0% |
| Q1 2025 | 57.603 | -1.1% |
| Q4 2024 | 58.216 | +2.7% |
| Q3 2024 | 56.658 | -1.1% |
| Q2 2024 | 57.307 | +2.8% |
| Q1 2024 | 55.73 | -1.2% |
| Q4 2023 | 56.412 | +2.9% |
| Q3 2023 | 54.811 | -1.1% |
| Q2 2023 | 55.417 | +2.8% |
| Q1 2023 | 53.914 | -1.2% |
| Q4 2022 | 54.548 | +2.7% |
| Q3 2022 | 53.139 | -1.0% |
| Q2 2022 | 53.699 | +2.7% |
| Q1 2022 | 52.30 | -0.9% |
| Q4 2021 | 52.754 | +2.7% |
| Q3 2021 | 51.349 | -0.5% |
| Q2 2021 | 51.616 | +1.9% |
| Q1 2021 | 50.648 | -0.4% |
| Q4 2020 | 50.846 | -0.5% |
| Q3 2020 | 51.08 | +1.8% |
| Q2 2020 | 50.171 | -0.2% |
| Q1 2020 | 50.264 | +1.8% |
| Q4 2019 | 49.389 | -0.4% |
| Q3 2019 | 49.584 | +0.8% |
| Q2 2019 | 49.204 | +0.4% |
| Q1 2019 | 48.987 | -0.7% |
| Q4 2018 | 49.351 | +1.6% |
| Q3 2018 | 48.574 | -0.3% |
| Q2 2018 | 48.705 | +1.8% |
| Q1 2018 | 47.866 | -0.2% |
| Q4 2017 | 47.965 | +1.7% |
| Q3 2017 | 47.178 | -0.3% |
| Q2 2017 | 47.297 | +1.6% |
| Q1 2017 | 46.541 | +0.1% |
| Q4 2016 | 46.495 | +1.6% |
| Q3 2016 | 45.765 | +0.1% |
| Q2 2016 | 45.699 | +0.0% |
| Q1 2016 | 45.695 | — |
Keytruda (pembrolizumab) is billed to Medicare Part B under HCPCS code J9271, with a billing unit of 1 mg. Total billed units depend on the administered dose.
Most solid-tumor indications: 200 mg every 3 weeks (or 400 mg q6wk) — 200 (or 400) billing units per dose (1 mg/unit). Administration is billed separately: 96413 (+96415 per additional hour) — chemotherapy/complex-drug IV infusion over 30 minutes.
At the Q3 2026 limit, a typical 200-unit dose carries an allowable of about $12,129.00. Medicare pays roughly $9,509.136 (80% less the 2% sequester) and the remaining ~$2,425.80 is patient or secondary coinsurance the practice still has to collect — before any administration revenue.
Yes. Keytruda 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.
$60.645 per 1 mg, effective July 1, 2026, per the CMS July 2026 ASP pricing file. That is down 1.0% from the prior quarter and up 3.6% year over year.
The archive holds 43 quarters for J9271, starting at $45.695 per 1 mg in Q1 2016. The all-time peak was $61.251 in Q2 2026; the current limit is $60.645.
The payment limit is set at ASP + 6% (currently implying an ASP of about $57.212 per 1 mg). After the 2% sequester on Medicare's 80% share, the effective add-on is roughly 4.3% — about $2.46 per 1 mg — when the full allowable is collected.
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/keytruda-j9271-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 J9271 against your acquisition cost, payer mix, and 835s — and prices the answer in dollars.