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Drug Trend · Gastroenterology · Rheumatology · Dermatology
Every Medicare Part B payment limit CMS has published for J3358 — 35 quarters since Q1 2018, about 9 years of pricing on one axis, with the biosimilars alongside. Public CMS data with our change framing; no contracted rates.
Ustekinumab is the defining margin event of 2026: six biosimilar Q-codes entered the file from Q4 2025, and several saw their payment limits collapse 70–87% within two quarters as launch pricing hit the ASP basis. A practice still acquiring at pre-wave prices while limits reset is underwater on arrival.
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 J3358 |
|---|---|---|---|---|
| Q9997 | Otulfi (ustekinumab-ttwe) | Q4 2025 | $8.552 | -25% |
| Q9998 | Selarsdi (ustekinumab-aekn) | Q4 2025 | $10.529 | -7% |
| Q9999 | Wezlana (ustekinumab-aauz) | Q4 2025 | $13.154 | 16% |
| Q5098 | ustekinumab-srlf | Q3 2026 | $11.551 | 2% |
| Q5099 | Pyzchiva (ustekinumab-stba) | Q4 2025 | $3.075 | -73% |
| Q5100 | Yesintek (ustekinumab-kfce) | Q4 2025 | $3.29 | -71% |
At the Q3 2026 limit of $11.356 per 1 mg, the implied ASP is about $10.713 and the on-paper add-on is $0.643 per 1 mg. After the 2% sequester on Medicare’s 80% share, the effective add-on is roughly 4.3% of ASP — about $0.461 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. Crohn's/UC IV induction is a single weight-tiered infusion — 260 mg (≤55 kg), 390 mg (55–85 kg), or 520 mg (>85 kg); at 1 mg per billing unit that's 260–520 units (390 typical). At the Q3 2026 limit of $11.356 per 1 mg, a typical 390-unit dose carries a Medicare allowable of about $4,428.84 — Medicare pays ~$3,472.211 after the sequester, and ~$885.768 rides on coinsurance collection. Part B spent $12.5 million on J3358 in 2023 across 2,405 beneficiaries (CMS Part B drug-spending data).
Administration. 96365 (+96366 per additional hour) — therapeutic IV infusion; maintenance is the SC form, billed separately.
Waste modifiers. Single-dose container — JW (documented discard) / JZ (no waste) modifiers required since July 2023. Run your own numbers on the buy-and-bill calculator.
The coding & patient-cost side. This page covers the provider-margin story; for Stelara IV’s full billing reference — dosing conversions, modifiers, admin CPT detail, payer policies, and what the patient owes — see Stelara IV on CareCost Estimate, our billing-reference sister site.
Where J3358stands in the national payers’ published sourcing programs (the office-vs-hospital setting distinction most coverage misses):
State law is the other half: the white-bagging laws-by-state tracker — 11 states currently ban payer sourcing mandates outright.
All 35 published quarters for J3358, newest first, as published per file version.
| Quarter | Limit ($/1 mg) | QoQ |
|---|---|---|
| Q3 2026 | 11.356 | -2.3% |
| Q2 2026 | 11.624 | -6.9% |
| Q1 2026 | 12.49 | -3.9% |
| Q4 2025 | 12.993 | -2.2% |
| Q3 2025 | 13.29 | +3.8% |
| Q2 2025 | 12.808 | +0.4% |
| Q1 2025 | 12.759 | -1.6% |
| Q4 2024 | 12.967 | +0.7% |
| Q3 2024 | 12.878 | +3.1% |
| Q2 2024 | 12.494 | -1.0% |
| Q1 2024 | 12.619 | +0.0% |
| Q4 2023 | 12.619 | +0.2% |
| Q3 2023 | 12.594 | +2.8% |
| Q2 2023 | 12.246 | -0.0% |
| Q1 2023 | 12.249 | -0.9% |
| Q4 2022 | 12.36 | +0.6% |
| Q3 2022 | 12.292 | +5.5% |
| Q2 2022 | 11.647 | +0.3% |
| Q1 2022 | 11.615 | -0.6% |
| Q4 2021 | 11.68 | -0.6% |
| Q3 2021 | 11.745 | +1.0% |
| Q2 2021 | 11.631 | -2.7% |
| Q1 2021 | 11.951 | -0.7% |
| Q4 2020 | 12.033 | -1.1% |
| Q3 2020 | 12.17 | +2.5% |
| Q2 2020 | 11.874 | -0.5% |
| Q1 2020 | 11.932 | -0.9% |
| Q4 2019 | 12.037 | +0.3% |
| Q3 2019 | 11.996 | -0.2% |
| Q2 2019 | 12.024 | -1.4% |
| Q1 2019 | 12.19 | -0.7% |
| Q4 2018 | 12.28 | -2.1% |
| Q3 2018 | 12.549 | -2.0% |
| Q2 2018 | 12.803 | -0.4% |
| Q1 2018 | 12.852 | — |
Stelara IV (ustekinumab) is billed to Medicare Part B under HCPCS code J3358, with a billing unit of 1 mg. Total billed units depend on the administered dose.
Crohn's/UC IV induction is a single weight-tiered infusion — 260 mg (≤55 kg), 390 mg (55–85 kg), or 520 mg (>85 kg); at 1 mg per billing unit that's 260–520 units (390 typical). Administration is billed separately: 96365 (+96366 per additional hour) — therapeutic IV infusion; maintenance is the SC form, billed separately.
At the Q3 2026 limit, a typical 390-unit dose carries an allowable of about $4,428.84. Medicare pays roughly $3,472.211 (80% less the 2% sequester) and the remaining ~$885.768 is patient or secondary coinsurance the practice still has to collect — before any administration revenue.
Yes. Stelara 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.
$11.356 per 1 mg, effective July 1, 2026, per the CMS July 2026 ASP pricing file. That is down 2.3% from the prior quarter and down 14.6% year over year.
The archive holds 35 quarters for J3358, starting at $12.852 per 1 mg in Q1 2018. The all-time peak was $13.29 in Q3 2025; the current limit is $11.356.
The payment limit is set at ASP + 6% (currently implying an ASP of about $10.713 per 1 mg). After the 2% sequester on Medicare's 80% share, the effective add-on is roughly 4.3% — about $0.461 per 1 mg — when the full allowable is collected.
Otulfi (ustekinumab-ttwe) (Q9997): $8.552 per 1 mg, in the file since Q4 2025. Selarsdi (ustekinumab-aekn) (Q9998): $10.529 per 1 mg, in the file since Q4 2025. Wezlana (ustekinumab-aauz) (Q9999): $13.154 per 1 mg, in the file since Q4 2025. ustekinumab-srlf (Q5098): $11.551 per 1 mg, in the file since Q3 2026. Pyzchiva (ustekinumab-stba) (Q5099): $3.075 per 1 mg, in the file since Q4 2025. Yesintek (ustekinumab-kfce) (Q5100): $3.29 per 1 mg, in the file since Q4 2025. Each code carries its own payment limit, so same-molecule economics can differ sharply by product.
ustekinumab was selected in the IRA's first negotiation cycle (IPAY-2026), with the negotiated price effective January 1, 2026. MFP-priced sales now flow into the ASP calculation — one of the structural forces behind this code's recent limit moves alongside biosimilar entry.
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/stelara-j3358-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 J3358 against your acquisition cost, payer mix, and 835s — and prices the answer in dollars.