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Medicare Part B payment limits Effective October 1 – December 31, 2026 Posted by CMS September 17, 2026

AfliberceptBevacizumabDenosumabEculizumabEpoetin alfaFilgrastimInfliximabNatalizumabPegfilgrastimRanibizumabRituximabTocilizumabTrastuzumabUstekinumab

Biosimilars · Ranibizumab

Ranibizumab: Lucentis and 3 biosimilars

3 biosimilars bill against Lucentis (J2778). On average they are paid ↑ 351.0% relative to the reference product per 0.1 mg in 4Q26.

  • Lucentis (reference)
  • Nufymco
  • Cimerli
  • Byooviz
Payment limit per 0.1 mg, last 8 quarters. Reference product as the thick navy line, biosimilars in teal and other colors.

All products

ProductCodeCMS descriptionPer 0.1 mgvs. referenceCMS 8% add-on note8 quarters
Lucentis J2778 Ranibizumab injection $26.384 Reference –
Nufymco Q5168 Inj. nufymco, 0.1 mg $26.384 0.0% No
Cimerli Q5128 Inj, cimerli, 0.1 mg $81.13 ↑ 207.5% No
Byooviz Q5124 Inj. byooviz, 0.1 mg $249.493 ↑ 845.6% No

Payment limits are from the CMS 4Q26 file. Which products are grouped together comes from the site’s biosimilar groups list (reference/biosimilar_groups/2026-10-17T183707Z_d3109bb50c53.csv), checked by hand; it is not a CMS file. “CMS 8% add-on note” shows whether CMS’s notes say the 8% of reference product add-on was applied.

Medicare Part B usage

Ranibizumab market in Medicare

$79.2M Medicare Part B spending, 2025 (preliminary)
122,851 claims in 2025 (preliminary); 1,931,715 billing units (0.1 mg each) in 2024
32.8% of 2025 claims were for biosimilars, vs. 57.9% in 2024
$5.15M spending so far in 2026 (Q1, preliminary)

Spending by product

Market share (share of claims)

Medicare Part B fee-for-service spending and claims by calendar year. Years marked “prelim.” come from CMS’s quarterly spending file and will be replaced when CMS publishes the yearly file. Market share is each product’s percent of the group’s claims that year; claims are used because the quarterly file has no dosage units. A product with no bar for a year is not in CMS’s file for that year.

By product

Product Spending 2024Units 2024Spending per unit 2024Spending 2025 (prelim.) Claims 2025Share of claims 2025 Spending 2026 (Q1)
Lucentis J2778 $128,919,304.60 808,761 $159.4034635 $44,798,421.18 82,587 67.2% $4,780,597.29
Nufymco Q5168 – – – – – – –
Cimerli Q5128 $216,885,671.10 950,268 $228.2363198 $30,172,535.31 34,255 27.9% $331,811.75
Byooviz Q5124 $29,305,816.68 172,686 $169.7058052 $4,244,844.27 6,009 4.9% $34,511.39

Spending, units and claims are CMS figures; spending per unit is CMS’s own average for 2024. Units are billing units, which can differ between codes, so compare units only between codes billed per the same amount. Shares are this site’s calculation from CMS claims. CMS may count spending differently in its quarterly and yearly files, so treat changes between 2024 and 2025 with care.

Physician-billed use by state, 2024

From CMS’s Physician & Other Practitioners by Geography and Service file, which covers drugs billed by physicians and other practitioners, mostly in offices. Drugs billed by hospital outpatient departments are not in it. For these products it covers 98.9% of 2024 Medicare units. CMS leaves out a state’s row for a product when fewer than 11 patients received it, so small states may undercount.

Hover over a state to see its figure. Territories and states with no data are in the table.

Show 51 states and territories
StateServices (billing units)Biosimilar share
Texas235,40147.2%
Pennsylvania232,18083.7%
California217,68767.2%
Florida146,16039.7%
Tennessee124,64294.0%
Maryland100,04078.7%
New York84,72669.7%
Mississippi68,28511.4%
Massachusetts65,47973.5%
Minnesota57,58090.1%
South Carolina53,74661.2%
Arizona53,62480.9%
Michigan49,97110.0%
New Jersey45,88659.0%
North Carolina27,45714.7%
Illinois24,67036.8%
Missouri23,89867.5%
Georgia21,2247.7%
Kansas20,91424.2%
Iowa20,49012.8%
Washington19,32656.6%
Indiana19,08958.2%
Colorado19,07448.9%
Virginia17,97639.4%
Louisiana13,23632.1%
Idaho12,47571.8%
Oklahoma12,34773.4%
Utah11,58425.4%
Alabama11,37787.7%
Oregon10,45825.5%
Montana10,31782.4%
Connecticut9,82250.9%
Ohio8,95543.2%
New Mexico8,6650.0%
Maine7,39538.8%
Kentucky7,25716.4%
South Dakota5,31357.1%
Wisconsin4,9510.0%
Arkansas4,75311.8%
Nebraska4,4479.6%
Delaware3,6340.0%
Nevada3,59339.1%
Wyoming2,31019.9%
Hawaii1,91457.7%
West Virginia1,1570.0%
Rhode Island1,1210.0%
New Hampshire1,1040.0%
North Dakota9500.0%
Vermont4950.0%
District of Columbia2300.0%
Alaska139100.0%

Sources: 2026-06-25_DSD_PTB_RY26_P06_V10_DYT24_HCPCS-260602.csv, 2026-05-21_MUP_PHY_R26_P05_V10_D24_Geo.csv.gz, 2026-07-23_qddptb_r2603_p06_v10_dqt2601_260722.csv (data.cms.gov).