HCPCS J0896: what Medicare pays in 2026
Drug CMS description: Inj luspatercept-aamt 0.25mg
Medicare's Part B payment limit for J0896 from October 1 to December 31, 2026 is $43.484 per billing unit of 0.25 MG. Check the number of units on your bill: drug lines are billed in these units.
Medicare amounts for J0896 in 2026
- Hospital outpatient rate, national (APC 9347)
- $43.51
- Hospital outpatient status K
- separately paid drug
- Part B drug payment limit per 0.25 MG
- $43.484
Hospital outpatient rates are national figures before Medicare's wage adjustment, which moves about 60% of the rate up or down with local hospital wages.
What providers charged Medicare for J0896 in 2024
From CMS's national utilization file (the most recent full year published). The charge is the provider's list price, the same kind of figure an uninsured patient is usually billed.
| Setting | Units billed | Average charge | Medicare allowed | Charge vs allowed |
|---|---|---|---|---|
| In an office or other non-facility setting | 8,333,762 | $95.61 | $39.43 | 2.4× |