J1958 Inj levetirac sodi chlo 5 mg

Injection, levetiracetam in sodium chloride, 5 mg

Medicare pricing for J1958

Medicare Part B drug payment limit (ASP, October 2026)

J1958 payment limit: $0.033 per 5 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%. Note: Added October 2026.

NDCs that bill under J1958 (CMS ASP NDC-HCPCS crosswalk, October 2026)

Physician Fee Schedule (CY 2026, RVU26D)

Status E: excluded from the PFS by regulation.

Payer policies and prior authorization for J1958

Payer coverage policies that name J1958

J1958 appears in 1 coverage policy from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaInjectable Medications (0020)listed, no stance (range J0278-J2543)Mar 5, 2026payer document

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.