| HCPCS Code | HCPCS Unit | HCPCS Code Descriptor |
| C9257 | 0.25 MG | |
| Manufacturer | Brand Name | Short Description |
| Genentech, Inc. | Avastin | Bevacizumab injection |
| < | September 2019 |
October 2019 |
November 2019 |
December 2019 |
January 2020 |
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Total NDC's Aligned to this HCPCS Code
|
2 | 2 | 2 | 2 | 2 | ||
| ASP: Average Sales Price | $.00 | $.00 | $.00 | $.00 | $.00 | ||
ASP+4.3%: Effective Payment Limit
|
$.00 | $.00 | $.00 | $.00 | $.00 | ||
| ASP+6%: Medicare Payment Limit | N/A | N/A | N/A | N/A | N/A | ||
| APC: Ambulatory Procedure Code Payment Limit | $2.03 | $2.03 | $2.03 | $2.02 | |||
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| HCPCS Code | HCPCS Unit | HCPCS Code Descriptor |
| J9035 | 10 MG | INJECTION, BEVACIZUMAB, 10 MG |
| Manufacturer | Brand Name | Short Description |
| Genentech, Inc. | AVASTIN | Bevacizumab injection |
| < | April 2019 |
May 2019 |
June 2019 |
July 2019 |
August 2019 |
> | |
Total NDC's Aligned to this HCPCS Code
|
2 | 2 | 2 | 2 | 2 | ||
| ASP: Average Sales Price | $76.62 | $76.62 | $76.62 | $76.68 | $76.68 | ||
ASP+4.3%: Effective Payment Limit
|
$79.92 | $79.92 | $79.92 | $79.98 | $79.98 | ||
| ASP+6%: Medicare Payment Limit | $81.22 | $81.22 | $81.22 | $81.28 | $81.28 | ||
| APC: Ambulatory Procedure Code Payment Limit | |||||||
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