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Drug Trend · Oncology
Every Medicare Part B payment limit CMS has published for J9299 — 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.
Opdivo's IV limit has drifted down from its 2016 debut while the franchise forked: Opdivo Qvantig, the subcutaneous formulation, got its own code in late 2025 at a lower per-mg limit. Watching the two lines diverge is watching the site-of-care fight in one chart.
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 J9299 |
|---|---|---|---|---|
| J9289 | Opdivo Qvantig SC (hyaluronidase) | Q4 2025 | $28.14 | -18% |
At the Q3 2026 limit of $34.222 per 1 mg, the implied ASP is about $32.285 and the on-paper add-on is $1.937 per 1 mg. After the 2% sequester on Medicare’s 80% share, the effective add-on is roughly 4.3% of ASP — about $1.388 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. Common solid-tumor dosing: 240 mg every 2 weeks or 480 mg every 4 weeks — 240 or 480 billing units per dose (1 mg/unit). At the Q3 2026 limit of $34.222 per 1 mg, a typical 240-unit dose carries a Medicare allowable of about $8,213.28 — Medicare pays ~$6,439.212 after the sequester, and ~$1,642.656 rides on coinsurance collection. Part B spent $1.91 billion on J9299 in 2023 across 27,383 beneficiaries (CMS Part B drug-spending data).
Administration. 96413 (+96415 per additional hour) — chemotherapy/complex-drug IV infusion over 30 minutes.
Waste modifiers. Single-dose container — JW (documented discard) / JZ (no waste) modifiers required since July 2023. Run your own numbers on the buy-and-bill calculator.
The coding & patient-cost side. This page covers the provider-margin story; for Opdivo’s full billing reference — dosing conversions, modifiers, admin CPT detail, payer policies, and what the patient owes — see Opdivo on CareCost Estimate, our billing-reference sister site.
Where J9299stands in the national payers’ published sourcing programs (the office-vs-hospital setting distinction most coverage misses):
State law is the other half: the white-bagging laws-by-state tracker — 11 states currently ban payer sourcing mandates outright.
All 43 published quarters for J9299, newest first, as published per file version.
| Quarter | Limit ($/1 mg) | QoQ |
|---|---|---|
| Q3 2026 | 34.222 | +1.8% |
| Q2 2026 | 33.624 | +0.2% |
| Q1 2026 | 33.573 | +1.8% |
| Q4 2025 | 32.964 | -0.1% |
| Q3 2025 | 33.002 | +2.0% |
| Q2 2025 | 32.352 | +0.2% |
| Q1 2025 | 32.296 | +1.7% |
| Q4 2024 | 31.75 | +0.5% |
| Q3 2024 | 31.596 | +1.6% |
| Q2 2024 | 31.094 | +0.0% |
| Q1 2024 | 31.089 | +2.2% |
| Q4 2023 | 30.426 | -0.1% |
| Q3 2023 | 30.457 | +1.8% |
| Q2 2023 | 29.911 | -0.3% |
| Q1 2023 | 30.001 | +1.5% |
| Q4 2022 | 29.547 | -0.5% |
| Q3 2022 | 29.685 | +1.5% |
| Q2 2022 | 29.238 | -0.0% |
| Q1 2022 | 29.245 | +1.3% |
| Q4 2021 | 28.863 | -0.1% |
| Q3 2021 | 28.895 | +1.4% |
| Q2 2021 | 28.487 | -0.2% |
| Q1 2021 | 28.541 | -0.1% |
| Q4 2020 | 28.559 | +0.1% |
| Q3 2020 | 28.534 | +1.3% |
| Q2 2020 | 28.162 | +0.0% |
| Q1 2020 | 28.162 | +1.3% |
| Q4 2019 | 27.805 | +0.0% |
| Q3 2019 | 27.804 | +1.2% |
| Q2 2019 | 27.464 | -0.1% |
| Q1 2019 | 27.498 | -0.2% |
| Q4 2018 | 27.541 | +1.4% |
| Q3 2018 | 27.155 | +0.0% |
| Q2 2018 | 27.152 | +1.4% |
| Q1 2018 | 26.787 | -0.1% |
| Q4 2017 | 26.804 | +1.4% |
| Q3 2017 | 26.422 | -0.0% |
| Q2 2017 | 26.428 | +1.5% |
| Q1 2017 | 26.047 | -0.1% |
| Q4 2016 | 26.064 | +1.4% |
| Q3 2016 | 25.694 | +0.3% |
| Q2 2016 | 25.616 | +1.0% |
| Q1 2016 | 25.37 | — |
Opdivo (nivolumab) is billed to Medicare Part B under HCPCS code J9299, with a billing unit of 1 mg. Total billed units depend on the administered dose.
Common solid-tumor dosing: 240 mg every 2 weeks or 480 mg every 4 weeks — 240 or 480 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 240-unit dose carries an allowable of about $8,213.28. Medicare pays roughly $6,439.212 (80% less the 2% sequester) and the remaining ~$1,642.656 is patient or secondary coinsurance the practice still has to collect — before any administration revenue.
Yes. Opdivo 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.
$34.222 per 1 mg, effective July 1, 2026, per the CMS July 2026 ASP pricing file. That is up 1.8% from the prior quarter and up 3.7% year over year.
The archive holds 43 quarters for J9299, starting at $25.37 per 1 mg in Q1 2016. The all-time peak was $34.222 in Q3 2026; the current limit is $34.222.
The payment limit is set at ASP + 6% (currently implying an ASP of about $32.285 per 1 mg). After the 2% sequester on Medicare's 80% share, the effective add-on is roughly 4.3% — about $1.388 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/opdivo-j9299-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 J9299 against your acquisition cost, payer mix, and 835s — and prices the answer in dollars.