Medically Unlikely Edits (effective October 1, 2026)
Practitioner: max 50 units per day (clinical), rationale: Prescribing Information
Outpatient hospital: max 50 units per day (clinical), rationale: Prescribing Information
DME supplier: max 0 units per day (clinical), rationale: CMS Policy
Medicare pricing for J3101
Medicare Part B drug payment limit (ASP, October 2026)
J3101 payment limit: $230.742 per 1 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 14.876%. Note: Inflation-adjusted coinsurance.
NDCs that bill under J3101 (CMS ASP NDC-HCPCS crosswalk, October 2026)
50242-0014-03 Tnkase, Genentech, Inc.: 25 billing units per package (1 KIT in 1 CARTON * 1 VIAL, SINGLE-USE in 1 CARTON / 5 mL in 1 VIAL, SINGLE-USE * 1 VIAL, SINGLE-USE in 1 CART)
50242-0120-47 Tnkase, Genentech, Inc.: 50 billing units per package (1 KIT in 1 CARTON * 1 VIAL, SINGLE-USE in 1 CARTON / 10 mL in 1 VIAL, SINGLE-USE * 1 VIAL, SINGLE-USE in 1 CAR)
50242-0176-01 Tnkase, Genentech, Inc.: 50 billing units per package (1 KIT in 1 CARTON * 1 VIAL, SINGLE-USE in 1 CARTON / 10 mL in 1 VIAL, SINGLE-USE * 1 VIAL, SINGLE-USE in 1 CAR)
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.