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Drug Trend · Neurology
Every Medicare Part B payment limit CMS has published for J2350 — 35 quarters since Q1 2018, about 9 years of pricing on one axis, with the formulations alongside. Public CMS data with our change framing; no contracted rates.
A stable high-value infusion franchise since 2018 — the payment limit has drifted up, not down. The 2025 subcutaneous formulation carries its own J-code at a meaningfully lower per-mg limit, which changes the in-office economics conversation even though the IV line is steady.
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 J2350 |
|---|---|---|---|---|
| J2351 | Ocrevus Zunovo SC (hya-ocsq) | Q2 2025 | $48.06 | -21% |
At the Q3 2026 limit of $60.97 per 1 mg, the implied ASP is about $57.519 and the on-paper add-on is $3.451 per 1 mg. After the 2% sequester on Medicare’s 80% share, the effective add-on is roughly 4.3% of ASP — about $2.473 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. MS maintenance: 600 mg IV every 6 months (after 2 × 300 mg initiation) — 600 billing units per maintenance dose (1 mg/unit). At the Q3 2026 limit of $60.97 per 1 mg, a typical 600-unit dose carries a Medicare allowable of about $36,582.00 — Medicare pays ~$28,680.288 after the sequester, and ~$7,316.40 rides on coinsurance collection. Part B spent $697.2 million on J2350 in 2023 across 12,154 beneficiaries (CMS Part B drug-spending data).
Administration. 96365 (+96366 per additional hour) — therapeutic IV infusion with premedication and post-infusion monitoring.
Waste modifiers. Single-dose container — JW (documented discard) / JZ (no waste) modifiers required since July 2023. Run your own numbers on the buy-and-bill calculator.
The coding & patient-cost side. This page covers the provider-margin story; for Ocrevus’s full billing reference — dosing conversions, modifiers, admin CPT detail, payer policies, and what the patient owes — see Ocrevus on CareCost Estimate, our billing-reference sister site.
Where J2350stands in the national payers’ published sourcing programs (the office-vs-hospital setting distinction most coverage misses):
State law is the other half: the white-bagging laws-by-state tracker — 11 states currently ban payer sourcing mandates outright.
All 35 published quarters for J2350, newest first, as published per file version.
| Quarter | Limit ($/1 mg) | QoQ |
|---|---|---|
| Q3 2026 | 60.97 | +2.3% |
| Q2 2026 | 59.596 | +0.5% |
| Q1 2026 | 59.324 | -0.2% |
| Q4 2025 | 59.414 | -0.5% |
| Q3 2025 | 59.704 | +3.3% |
| Q2 2025 | 57.807 | -1.6% |
| Q1 2025 | 58.766 | -1.7% |
| Q4 2024 | 59.798 | -0.8% |
| Q3 2024 | 60.251 | +2.5% |
| Q2 2024 | 58.756 | -1.7% |
| Q1 2024 | 59.751 | -1.3% |
| Q4 2023 | 60.545 | -1.4% |
| Q3 2023 | 61.417 | +4.2% |
| Q2 2023 | 58.967 | -1.2% |
| Q1 2023 | 59.654 | -0.7% |
| Q4 2022 | 60.082 | -0.7% |
| Q3 2022 | 60.492 | +3.4% |
| Q2 2022 | 58.493 | -0.7% |
| Q1 2022 | 58.907 | +1.1% |
| Q4 2021 | 58.291 | -0.5% |
| Q3 2021 | 58.576 | +2.3% |
| Q2 2021 | 57.244 | -0.1% |
| Q1 2021 | 57.326 | -0.1% |
| Q4 2020 | 57.383 | -0.0% |
| Q3 2020 | 57.40 | -0.0% |
| Q2 2020 | 57.417 | +0.0% |
| Q1 2020 | 57.417 | +0.0% |
| Q4 2019 | 57.417 | +0.0% |
| Q3 2019 | 57.417 | +0.0% |
| Q2 2019 | 57.406 | +0.1% |
| Q1 2019 | 57.371 | +0.0% |
| Q4 2018 | 57.344 | +0.3% |
| Q3 2018 | 57.174 | +0.0% |
| Q2 2018 | 57.164 | +0.1% |
| Q1 2018 | 57.083 | — |
Ocrevus (ocrelizumab) is billed to Medicare Part B under HCPCS code J2350, with a billing unit of 1 mg. Total billed units depend on the administered dose.
MS maintenance: 600 mg IV every 6 months (after 2 × 300 mg initiation) — 600 billing units per maintenance dose (1 mg/unit). Administration is billed separately: 96365 (+96366 per additional hour) — therapeutic IV infusion with premedication and post-infusion monitoring.
At the Q3 2026 limit, a typical 600-unit dose carries an allowable of about $36,582.00. Medicare pays roughly $28,680.288 (80% less the 2% sequester) and the remaining ~$7,316.40 is patient or secondary coinsurance the practice still has to collect — before any administration revenue.
Yes. Ocrevus 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.
$60.97 per 1 mg, effective July 1, 2026, per the CMS July 2026 ASP pricing file. That is up 2.3% from the prior quarter and up 2.1% year over year.
The archive holds 35 quarters for J2350, starting at $57.083 per 1 mg in Q1 2018. The all-time peak was $61.417 in Q3 2023; the current limit is $60.97.
The payment limit is set at ASP + 6% (currently implying an ASP of about $57.519 per 1 mg). After the 2% sequester on Medicare's 80% share, the effective add-on is roughly 4.3% — about $2.473 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/ocrevus-j2350-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 J2350 against your acquisition cost, payer mix, and 835s — and prices the answer in dollars.