Products billed under this code include Flublok Trivalent (2025/2026) (Preservative free).
Payment limit per 0.5 ML, by effective quarter, 4Q24 to 4Q26. Gaps mean the code was not in that quarter’s file, or CMS gave no payment limit.From the 4Q26 NDC–HCPCS crosswalk. “Limit / pkg” is the 4Q26 payment limit times the billing units in one package.
| Product | Labeler | NDC | Units / pkg | Limit / pkg |
|---|---|---|---|---|
| Flublok Trivalent (2025/2026) (Preservative free) | Sanofi Pasteur | 49281-0725-10 | 10 | $1,225.22 |
| Quarter | Payment limit | Change | Billing unit | Description | Source file |
|---|---|---|---|---|---|
| 4Q26 | $122.522 | +$24.362 | 0.5 ML | Riv3 vaccine no preserv im | v1, posted September 17, 2026 |
| 3Q26 | $98.16 | $0.00 | 0.5 ML | Riv3 vaccine no preserv im | v1, posted September 15, 2026 |
| 2Q26 | $98.16 | $0.00 | 0.5 ML | Riv3 vaccine no preserv im | v1, posted September 15, 2026 |
| 1Q26 | $98.16 | $0.00 | 0.5 ML | Riv3 vaccine no preserv im | v1, posted September 15, 2026 |
| 4Q25 | $98.16 | +$14.668 | 0.5 ML | Riv3 vaccine no preserv im | v1, posted September 8, 2026 |
| 3Q25 | $83.492 | $0.00 | 0.5 ML | Riv3 vaccine no preserv im | v1, posted March 10, 2026 |
| 2Q25 | $83.492 | $0.00 | 0.5 ML | Riv3 vaccine no preserv im | v1, posted March 10, 2026 |
| 1Q25 | $83.492 | $0.00 | 0.5 ML | Riv3 vaccine no preserv im | v1, posted December 19, 2025 |
| 4Q24 | $83.492 | – | 0.5 ML | Riv3 vaccine no preserv im | v1, posted June 11, 2025 |
“Change” is the difference from the previous quarter, shown only when both quarters have a payment limit and the billing unit is the same. “vs. last quarter” and “vs. a year ago” follow the same rule.
