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Drug Trend · Oncology · Rheumatology
Every Medicare Part B payment limit CMS has published for J9312 — 31 quarters since Q1 2019, about 8 years of pricing on one axis, with the biosimilars alongside. Public CMS data with our change framing; no contracted rates.
Rituximab's modern code (J9312) only goes back to 2019, but its retired 100 mg predecessor (J9310, shown ÷10 on the same axis) extends the record to 2005 — two decades of one molecule's pricing in a single chart. Biosimilars now sit 50–80% below where the brand traded at the 2018 handoff.
CMS payment limit (ASP + 6% basis) by quarter, as published. Dashed series are unit-converted as labeled.
Every code carries its own payment limit — same-molecule economics can differ by 50%+ between products.
| HCPCS | Product | In file since | Current limit | vs J9312 |
|---|---|---|---|---|
| Q5115 | Truxima (rituximab-abbs) | Q1 2020 | $34.563 | -53% |
| Q5119 | Ruxience (rituximab-pvvr) | Q3 2020 | $16.16 | -78% |
| Q5123 | Riabni (rituximab-arrx) | Q3 2021 | $18.533 | -75% |
At the Q3 2026 limit of $73.278 per 10 mg, the implied ASP is about $69.13 and the on-paper add-on is $4.148 per 10 mg. After the 2% sequester on Medicare’s 80% share, the effective add-on is roughly 4.3% of ASP — about $2.973 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. B-cell NHL: 375 mg/m² per infusion — at a typical 1.86 m² BSA that's ~700 mg = ~70 billing units (10 mg/unit); RA is two 1,000 mg infusions. At the Q3 2026 limit of $73.278 per 10 mg, a typical 70-unit dose carries a Medicare allowable of about $5,129.46 — Medicare pays ~$4,021.497 after the sequester, and ~$1,025.892 rides on coinsurance collection. Part B spent $483.7 million on J9312 in 2023 across 23,994 beneficiaries (CMS Part B drug-spending data).
Administration. 96413 (+96415 per additional hour) — chemotherapy/complex-biologic IV infusion.
Waste modifiers. Single-dose container — JW (documented discard) / JZ (no waste) modifiers required since July 2023. Run your own numbers on the buy-and-bill calculator.
The coding & patient-cost side. This page covers the provider-margin story; for Rituxan’s full billing reference — dosing conversions, modifiers, admin CPT detail, payer policies, and what the patient owes — see Rituxan on CareCost Estimate, our billing-reference sister site.
Where J9312stands in the national payers’ published sourcing programs (the office-vs-hospital setting distinction most coverage misses):
State law is the other half: the white-bagging laws-by-state tracker — 11 states currently ban payer sourcing mandates outright.
All 31 published quarters for J9312, newest first, as published per file version.
| Quarter | Limit ($/10 mg) | QoQ |
|---|---|---|
| Q3 2026 | 73.278 | -1.2% |
| Q2 2026 | 74.158 | -0.8% |
| Q1 2026 | 74.765 | -0.6% |
| Q4 2025 | 75.22 | -0.9% |
| Q3 2025 | 75.931 | -0.7% |
| Q2 2025 | 76.433 | -0.4% |
| Q1 2025 | 76.73 | -0.8% |
| Q4 2024 | 77.314 | -0.5% |
| Q3 2024 | 77.675 | -1.5% |
| Q2 2024 | 78.872 | -0.4% |
| Q1 2024 | 79.198 | -1.2% |
| Q4 2023 | 80.192 | -1.0% |
| Q3 2023 | 81.037 | -0.2% |
| Q2 2023 | 81.187 | -0.7% |
| Q1 2023 | 81.748 | -0.6% |
| Q4 2022 | 82.251 | -2.3% |
| Q3 2022 | 84.166 | -1.5% |
| Q2 2022 | 85.435 | -0.2% |
| Q1 2022 | 85.633 | -1.5% |
| Q4 2021 | 86.937 | -1.0% |
| Q3 2021 | 87.775 | -1.5% |
| Q2 2021 | 89.141 | -2.9% |
| Q1 2021 | 91.836 | -0.8% |
| Q4 2020 | 92.556 | -0.9% |
| Q3 2020 | 93.366 | -0.9% |
| Q2 2020 | 94.178 | -0.2% |
| Q1 2020 | 94.411 | -0.3% |
| Q4 2019 | 94.667 | -0.3% |
| Q3 2019 | 94.973 | -0.2% |
| Q2 2019 | 95.20 | -0.2% |
| Q1 2019 | 95.397 | — |
Rituxan (rituximab) is billed to Medicare Part B under HCPCS code J9312, with a billing unit of 10 mg. Total billed units depend on the administered dose.
B-cell NHL: 375 mg/m² per infusion — at a typical 1.86 m² BSA that's ~700 mg = ~70 billing units (10 mg/unit); RA is two 1,000 mg infusions. Administration is billed separately: 96413 (+96415 per additional hour) — chemotherapy/complex-biologic IV infusion.
At the Q3 2026 limit, a typical 70-unit dose carries an allowable of about $5,129.46. Medicare pays roughly $4,021.497 (80% less the 2% sequester) and the remaining ~$1,025.892 is patient or secondary coinsurance the practice still has to collect — before any administration revenue.
Yes. Rituxan 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.
$73.278 per 10 mg, effective July 1, 2026, per the CMS July 2026 ASP pricing file. That is down 1.2% from the prior quarter and down 3.5% year over year.
The archive holds 31 quarters for J9312, starting at $95.397 per 10 mg in Q1 2019. The all-time peak was $95.397 in Q1 2019; the current limit is $73.278.
The payment limit is set at ASP + 6% (currently implying an ASP of about $69.13 per 10 mg). After the 2% sequester on Medicare's 80% share, the effective add-on is roughly 4.3% — about $2.973 per 10 mg — when the full allowable is collected.
Truxima (rituximab-abbs) (Q5115): $34.563 per 10 mg, in the file since Q1 2020. Ruxience (rituximab-pvvr) (Q5119): $16.16 per 10 mg, in the file since Q3 2020. Riabni (rituximab-arrx) (Q5123): $18.533 per 10 mg, in the file since Q3 2021. 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/rituxan-j9312-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 J9312 against your acquisition cost, payer mix, and 835s — and prices the answer in dollars.