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Drug Trend · Gastroenterology · Rheumatology
Every Medicare Part B payment limit CMS has published for J1745 — 87 quarters since Q1 2005, about 22 years of pricing on one axis, with the biosimilars alongside. Public CMS data with our change framing; no contracted rates.
The canonical decade-long ASP collapse: from $53/10 mg in 2005 to about $31 today, with the steepest slide after biosimilars arrived in 2017. Infliximab biosimilars are also the poster child of the underwater-biosimilars problem — practice surveys have documented acquisition costs above the ASP-based limit on some products.
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 J1745 |
|---|---|---|---|---|
| Q5103 | Inflectra (infliximab-dyyb) | Q2 2018 | $27.71 | -12% |
| Q5104 | Renflexis (infliximab-abda) | Q2 2018 | $26.615 | -15% |
| Q5121 | Avsola (infliximab-axxq) | Q4 2020 | $30.83 | -2% |
At the Q3 2026 limit of $31.479 per 10 mg, the implied ASP is about $29.697 and the on-paper add-on is $1.782 per 10 mg. After the 2% sequester on Medicare’s 80% share, the effective add-on is roughly 4.3% of ASP — about $1.277 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. Crohn's/UC: 5 mg/kg at weeks 0, 2, 6, then every 8 weeks — a 70-kg patient is 350 mg = 35 billing units (10 mg/unit); RA dosing is 3 mg/kg. At the Q3 2026 limit of $31.479 per 10 mg, a typical 35-unit dose carries a Medicare allowable of about $1,101.765 — Medicare pays ~$863.784 after the sequester, and ~$220.353 rides on coinsurance collection. Part B spent $389.7 million on J1745 in 2023 across 38,091 beneficiaries (CMS Part B drug-spending data).
Administration. 96365 (+96366 per additional hour) — therapeutic IV infusion, typically ≥2 hours with an in-line filter.
Waste modifiers. Single-dose container — JW (documented discard) / JZ (no waste) modifiers required since July 2023. Run your own numbers on the buy-and-bill calculator.
The coding & patient-cost side. This page covers the provider-margin story; for Remicade’s full billing reference — dosing conversions, modifiers, admin CPT detail, payer policies, and what the patient owes — see Remicade on CareCost Estimate, our billing-reference sister site.
Where J1745stands in the national payers’ published sourcing programs (the office-vs-hospital setting distinction most coverage misses):
State law is the other half: the white-bagging laws-by-state tracker — 11 states currently ban payer sourcing mandates outright.
All 87 published quarters for J1745, newest first, as published per file version.
| Quarter | Limit ($/10 mg) | QoQ |
|---|---|---|
| Q3 2026 | 31.479 | +1.4% |
| Q2 2026 | 31.041 | -4.3% |
| Q1 2026 | 32.423 | +4.3% |
| Q4 2025 | 31.09 | -0.3% |
| Q3 2025 | 31.179 | +2.1% |
| Q2 2025 | 30.523 | -0.0% |
| Q1 2025 | 30.525 | -5.3% |
| Q4 2024 | 32.223 | +1.6% |
| Q3 2024 | 31.707 | +0.1% |
| Q2 2024 | 31.671 | -1.5% |
| Q1 2024 | 32.161 | -1.5% |
| Q4 2023 | 32.637 | -0.8% |
| Q3 2023 | 32.907 | -3.3% |
| Q2 2023 | 34.043 | -2.3% |
| Q1 2023 | 34.862 | -0.5% |
| Q4 2022 | 35.022 | -1.9% |
| Q3 2022 | 35.713 | -2.2% |
| Q2 2022 | 36.513 | -3.1% |
| Q1 2022 | 37.682 | -4.7% |
| Q4 2021 | 39.532 | -4.3% |
| Q3 2021 | 41.319 | -1.5% |
| Q2 2021 | 41.952 | -6.6% |
| Q1 2021 | 44.902 | -5.7% |
| Q4 2020 | 47.62 | -7.0% |
| Q3 2020 | 51.20 | -8.1% |
| Q2 2020 | 55.696 | -2.9% |
| Q1 2020 | 57.346 | -9.4% |
| Q4 2019 | 63.285 | -2.4% |
| Q3 2019 | 64.873 | -9.6% |
| Q2 2019 | 71.76 | -6.4% |
| Q1 2019 | 76.649 | -2.8% |
| Q4 2018 | 78.833 | -6.0% |
| Q3 2018 | 83.899 | +0.7% |
| Q2 2018 | 83.287 | -2.9% |
| Q1 2018 | 85.811 | -1.5% |
| Q4 2017 | 87.149 | +1.6% |
| Q3 2017 | 85.74 | +0.2% |
| Q2 2017 | 85.591 | +4.1% |
| Q1 2017 | 82.218 | -0.8% |
| Q4 2016 | 82.872 | +0.7% |
| Q3 2016 | 82.281 | +0.8% |
| Q2 2016 | 81.596 | +2.1% |
| Q1 2016 | 79.905 | +1.5% |
| Q4 2015 | 78.758 | +2.4% |
| Q3 2015 | 76.891 | +0.5% |
| Q2 2015 | 76.507 | +3.2% |
| Q1 2015 | 74.113 | -0.3% |
| Q4 2014 | 74.341 | +3.2% |
| Q3 2014 | 72.054 | +1.0% |
| Q2 2014 | 71.347 | +1.8% |
| Q1 2014 | 70.109 | +0.2% |
| Q4 2013 | 69.958 | +2.9% |
| Q3 2013 | 67.955 | +0.4% |
| Q2 2013 | 67.675 | +1.9% |
| Q1 2013 | 66.407 | +1.9% |
| Q4 2012 | 65.179 | +1.4% |
| Q3 2012 | 64.261 | +1.2% |
| Q2 2012 | 63.525 | +1.3% |
| Q1 2012 | 62.68 | -0.8% |
| Q4 2011 | 63.203 | +4.2% |
| Q3 2011 | 60.672 | +1.1% |
| Q2 2011 | 60.041 | -0.9% |
| Q1 2011 | 60.581 | +0.1% |
| Q4 2010 | 60.53 | +3.3% |
| Q3 2010 | 58.587 | -0.3% |
| Q2 2010 | 58.74 | +0.1% |
| Q1 2010 | 58.664 | -0.1% |
| Q4 2009 | 58.712 | +3.7% |
| Q3 2009 | 56.625 | -0.2% |
| Q2 2009 | 56.748 | -0.3% |
| Q1 2009 | 56.929 | -0.3% |
| Q4 2008 | 57.078 | +3.5% |
| Q3 2008 | 55.152 | +0.2% |
| Q2 2008 | 55.042 | -0.3% |
| Q1 2008 | 55.206 | +0.5% |
| Q4 2007 | 54.936 | +2.4% |
| Q3 2007 | 53.623 | -0.2% |
| Q2 2007 | 53.756 | +0.0% |
| Q1 2007 | 53.73 | -0.0% |
| Q4 2006 | 53.743 | -1.5% |
| Q3 2006 | 54.556 | +0.6% |
| Q2 2006 | 54.242 | +1.9% |
| Q1 2006 | 53.241 | -0.4% |
| Q4 2005 | 53.428 | +0.2% |
| Q3 2005 | 53.322 | +0.2% |
| Q2 2005 | 53.21 | +0.2% |
| Q1 2005 | 53.091 | — |
Remicade (infliximab) is billed to Medicare Part B under HCPCS code J1745, with a billing unit of 10 mg. Total billed units depend on the administered dose.
Crohn's/UC: 5 mg/kg at weeks 0, 2, 6, then every 8 weeks — a 70-kg patient is 350 mg = 35 billing units (10 mg/unit); RA dosing is 3 mg/kg. Administration is billed separately: 96365 (+96366 per additional hour) — therapeutic IV infusion, typically ≥2 hours with an in-line filter.
At the Q3 2026 limit, a typical 35-unit dose carries an allowable of about $1,101.765. Medicare pays roughly $863.784 (80% less the 2% sequester) and the remaining ~$220.353 is patient or secondary coinsurance the practice still has to collect — before any administration revenue.
Yes. Remicade 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.
$31.479 per 10 mg, effective July 1, 2026, per the CMS July 2026 ASP pricing file. That is up 1.4% from the prior quarter and up 1.0% year over year.
The archive holds 87 quarters for J1745, starting at $53.091 per 10 mg in Q1 2005. The all-time peak was $87.149 in Q4 2017; the current limit is $31.479.
The payment limit is set at ASP + 6% (currently implying an ASP of about $29.697 per 10 mg). After the 2% sequester on Medicare's 80% share, the effective add-on is roughly 4.3% — about $1.277 per 10 mg — when the full allowable is collected.
Inflectra (infliximab-dyyb) (Q5103): $27.71 per 10 mg, in the file since Q2 2018. Renflexis (infliximab-abda) (Q5104): $26.615 per 10 mg, in the file since Q2 2018. Avsola (infliximab-axxq) (Q5121): $30.83 per 10 mg, in the file since Q4 2020. Each code carries its own payment limit, so same-molecule economics can differ sharply by product.
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/remicade-j1745-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 J1745 against your acquisition cost, payer mix, and 835s — and prices the answer in dollars.