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Drug Trend · Rheumatology
Every Medicare Part B payment limit CMS has published for J0129 — 79 quarters since Q1 2007, about 20 years of pricing on one axis. Public CMS data with our change framing; no contracted rates.
The highest-spend Part B drug in the IPAY-2028 class — $903M across 32,541 beneficiaries in CY2023. No abatacept biosimilar is on the market (Dr. Reddy's candidate is pending FDA review), and the self-injected SC form flows to Part D, so the J0129 line meets its 2028 negotiated price with no competitive cushion.
CMS payment limit (ASP + 6% basis) by quarter, as published.
At the Q3 2026 limit of $45.859 per 10 mg, the implied ASP is about $43.263 and the on-paper add-on is $2.596 per 10 mg. After the 2% sequester on Medicare’s 80% share, the effective add-on is roughly 4.3% of ASP — about $1.86 per 10 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. RA/PsA IV: weight-tiered — 500 mg (<60 kg), 750 mg (60–100 kg), 1,000 mg (>100 kg) at weeks 0, 2, 4, then every 4 weeks; 750 mg = 75 billing units (10 mg/unit), 30-minute infusion. At the Q3 2026 limit of $45.859 per 10 mg, a typical 75-unit dose carries a Medicare allowable of about $3,439.425 — Medicare pays ~$2,696.509 after the sequester, and ~$687.885 rides on coinsurance collection. Part B spent $902.5 million on J0129 in 2023 across 32,541 beneficiaries (CMS Part B drug-spending data).
Administration. 96365 — therapeutic IV infusion, initial up to 1 hour; the standard 30-minute Orencia infusion doesn't reach the +96366 add-on.
Waste modifiers. Single-dose container — JW (documented discard) / JZ (no waste) modifiers required since July 2023. Run your own numbers on the buy-and-bill calculator.
The coding & patient-cost side. For billing references across 370+ drugs (dosing conversions, modifiers, payer policies, patient cost), see CareCost Estimate’s drug library, our billing-reference sister site.
Where J0129stands in the national payers’ published sourcing programs (the office-vs-hospital setting distinction most coverage misses):
State law is the other half: the white-bagging laws-by-state tracker — 11 states currently ban payer sourcing mandates outright.
All 79 published quarters for J0129, newest first, as published per file version.
| Quarter | Limit ($/10 mg) | QoQ |
|---|---|---|
| Q3 2026 | 45.859 | +2.6% |
| Q2 2026 | 44.718 | -0.1% |
| Q1 2026 | 44.769 | +1.5% |
| Q4 2025 | 44.109 | -0.9% |
| Q3 2025 | 44.494 | +2.6% |
| Q2 2025 | 43.377 | -1.0% |
| Q1 2025 | 43.797 | +0.8% |
| Q4 2024 | 43.437 | -0.7% |
| Q3 2024 | 43.727 | +2.1% |
| Q2 2024 | 42.84 | -0.7% |
| Q1 2024 | 43.163 | +1.1% |
| Q4 2023 | 42.70 | -1.3% |
| Q3 2023 | 43.271 | +1.2% |
| Q2 2023 | 42.761 | -1.7% |
| Q1 2023 | 43.498 | +0.6% |
| Q4 2022 | 43.246 | -2.2% |
| Q3 2022 | 44.22 | +0.7% |
| Q2 2022 | 43.90 | -1.4% |
| Q1 2022 | 44.522 | -1.7% |
| Q4 2021 | 45.269 | -0.1% |
| Q3 2021 | 45.323 | -21.6% |
| Q2 2021 | 57.831 | +1.7% |
| Q1 2021 | 56.867 | -2.1% |
| Q4 2020 | 58.103 | +2.4% |
| Q3 2020 | 56.739 | +3.0% |
| Q2 2020 | 55.083 | +0.4% |
| Q1 2020 | 54.849 | +1.0% |
| Q4 2019 | 54.318 | +0.7% |
| Q3 2019 | 53.944 | +2.8% |
| Q2 2019 | 52.49 | +1.7% |
| Q1 2019 | 51.614 | -2.5% |
| Q4 2018 | 52.929 | +2.5% |
| Q3 2018 | 51.628 | +2.9% |
| Q2 2018 | 50.164 | +3.3% |
| Q1 2018 | 48.549 | -2.1% |
| Q4 2017 | 49.589 | +4.2% |
| Q3 2017 | 47.613 | +1.6% |
| Q2 2017 | 46.857 | +2.1% |
| Q1 2017 | 45.88 | +2.5% |
| Q4 2016 | 44.75 | +6.6% |
| Q3 2016 | 41.981 | +2.3% |
| Q2 2016 | 41.05 | +4.1% |
| Q1 2016 | 39.442 | +5.7% |
| Q4 2015 | 37.331 | +4.2% |
| Q3 2015 | 35.814 | +2.6% |
| Q2 2015 | 34.922 | +5.3% |
| Q1 2015 | 33.154 | +2.8% |
| Q4 2014 | 32.248 | +0.1% |
| Q3 2014 | 32.214 | +34.9% |
| Q2 2014 | 23.877 | +1.9% |
| Q1 2014 | 23.427 | +1.6% |
| Q4 2013 | 23.06 | +1.0% |
| Q3 2013 | 22.841 | +1.0% |
| Q2 2013 | 22.62 | +1.0% |
| Q1 2013 | 22.398 | +0.9% |
| Q4 2012 | 22.194 | +1.2% |
| Q3 2012 | 21.934 | +1.2% |
| Q2 2012 | 21.682 | +1.4% |
| Q1 2012 | 21.389 | +1.3% |
| Q4 2011 | 21.122 | +1.0% |
| Q3 2011 | 20.916 | +1.3% |
| Q2 2011 | 20.647 | +1.1% |
| Q1 2011 | 20.43 | +1.2% |
| Q4 2010 | 20.185 | +1.8% |
| Q3 2010 | 19.828 | -0.7% |
| Q2 2010 | 19.959 | +2.2% |
| Q1 2010 | 19.521 | +0.9% |
| Q4 2009 | 19.347 | +1.0% |
| Q3 2009 | 19.148 | -0.0% |
| Q2 2009 | 19.149 | +0.0% |
| Q1 2009 | 19.141 | +2.4% |
| Q4 2008 | 18.689 | +0.0% |
| Q3 2008 | 18.689 | +0.0% |
| Q2 2008 | 18.689 | +0.0% |
| Q1 2008 | 18.688 | +0.0% |
| Q4 2007 | 18.688 | +0.0% |
| Q3 2007 | 18.688 | +0.0% |
| Q2 2007 | 18.688 | -0.1% |
| Q1 2007 | 18.698 | — |
Orencia IV (abatacept) is billed to Medicare Part B under HCPCS code J0129, with a billing unit of 10 mg. Total billed units depend on the administered dose.
RA/PsA IV: weight-tiered — 500 mg (<60 kg), 750 mg (60–100 kg), 1,000 mg (>100 kg) at weeks 0, 2, 4, then every 4 weeks; 750 mg = 75 billing units (10 mg/unit), 30-minute infusion. Administration is billed separately: 96365 — therapeutic IV infusion, initial up to 1 hour; the standard 30-minute Orencia infusion doesn't reach the +96366 add-on.
At the Q3 2026 limit, a typical 75-unit dose carries an allowable of about $3,439.425. Medicare pays roughly $2,696.509 (80% less the 2% sequester) and the remaining ~$687.885 is patient or secondary coinsurance the practice still has to collect — before any administration revenue.
Yes. Orencia IV 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.
$45.859 per 10 mg, effective July 1, 2026, per the CMS July 2026 ASP pricing file. That is up 2.6% from the prior quarter and up 3.1% year over year.
The archive holds 79 quarters for J0129, starting at $18.698 per 10 mg in Q1 2007. The all-time peak was $58.103 in Q4 2020; the current limit is $45.859.
The payment limit is set at ASP + 6% (currently implying an ASP of about $43.263 per 10 mg). After the 2% sequester on Medicare's 80% share, the effective add-on is roughly 4.3% — about $1.86 per 10 mg — when the full allowable is collected.
Yes — abatacept 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/orencia-j0129-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 J0129 against your acquisition cost, payer mix, and 835s — and prices the answer in dollars.