Products billed under this code include Clariscan, Dotarem, Gadoterate Meglumine.
Payment limit per 0.1 ML, by effective quarter, 1Q21 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 |
|---|---|---|---|---|
| Clariscan | GE Healthcare Inc. | 00407-2943-01 | 1000 | $105.00 |
| Clariscan | GE Healthcare Inc. | 00407-2943-02 | 1500 | $157.50 |
| Clariscan | GE Healthcare Inc. | 00407-2943-05 | 2000 | $210.00 |
| Dotarem | Guerbet LLC | 67684-2000-00 | 500 | $52.50 |
| Dotarem | Guerbet LLC | 67684-2000-01 | 1000 | $105.00 |
| Dotarem | Guerbet LLC | 67684-2000-05 | 500 | $52.50 |
| Dotarem | Guerbet LLC | 67684-2000-06 | 750 | $78.75 |
| Dotarem | Guerbet LLC | 67684-2001-00 | 500 | $52.50 |
| Dotarem | Guerbet LLC | 67684-2001-01 | 1000 | $105.00 |
| Dotarem | Guerbet LLC | 67684-2001-02 | 1500 | $157.50 |
| Product | Labeler | NDC | Units / pkg | Limit / pkg |
|---|---|---|---|---|
| Dotarem | Guerbet LLC | 67684-2001-03 | 2000 | $210.00 |
| Dotarem | Guerbet LLC | 67684-2001-04 | 6000 | $630.00 |
| Dotarem | Guerbet LLC | 67684-3001-01 | 1000 | $105.00 |
| Dotarem | Guerbet LLC | 67684-3001-02 | 1500 | $157.50 |
| Dotarem | Guerbet LLC | 67684-3001-03 | 2000 | $210.00 |
| Gadoterate Meglumine | GE Healthcare Inc. | 00407-2943-06 | 500 | $52.50 |
| Gadoterate Meglumine | GE Healthcare Inc. | 00407-2943-12 | 1000 | $105.00 |
| Gadoterate Meglumine | GE Healthcare Inc. | 00407-2943-17 | 1500 | $157.50 |
| Gadoterate Meglumine | GE Healthcare Inc. | 00407-2943-22 | 2000 | $210.00 |
| Gadoterate Meglumine | GE Healthcare Inc. | 00407-2943-70 | 10000 | $1,050.00 |
| Gadoterate Meglumine | FreseniUS Kabi USA, LLC | 65219-0080-05 | 500 | $52.50 |
| Gadoterate Meglumine | FreseniUS Kabi USA, LLC | 65219-0082-10 | 1000 | $105.00 |
| Gadoterate Meglumine | FreseniUS Kabi USA, LLC | 65219-0084-15 | 1500 | $157.50 |
| Gadoterate Meglumine | FreseniUS Kabi USA, LLC | 65219-0086-20 | 2000 | $210.00 |
| Gadoterate Meglumine | FreseniUS Kabi USA, LLC | 65219-0088-50 | 6000 | $630.00 |
| Gadoterate Meglumine | Slate Run Pharmaceuticals | 70436-0123-31 | 500 | $52.50 |
| Gadoterate Meglumine | Slate Run Pharmaceuticals | 70436-0123-33 | 1000 | $105.00 |
| Gadoterate Meglumine | Slate Run Pharmaceuticals | 70436-0123-34 | 1500 | $157.50 |
| Gadoterate Meglumine | Slate Run Pharmaceuticals | 70436-0123-35 | 2000 | $210.00 |
| Gadoterate Meglumine | Slate Run Pharmaceuticals | 70436-0123-56 | 6000 | $630.00 |
| Quarter | Payment limit | Change | Billing unit | Description | Source file |
|---|---|---|---|---|---|
| 4Q26 | $0.105 | +$0.015 | 0.1 ML | Inj gadoterate meglumi 0.1ml | v1, posted September 17, 2026 |
| 3Q26 | $0.09 | $0.00 | 0.1 ML | Inj gadoterate meglumi 0.1ml | v1, posted September 15, 2026 |
| 2Q26 | $0.09 | −$0.013 | 0.1 ML | Inj gadoterate meglumi 0.1ml | v1, posted September 15, 2026 |
| 1Q26 | $0.103 | −$0.01 | 0.1 ML | Inj gadoterate meglumi 0.1ml | v1, posted September 15, 2026 |
| 4Q25 | $0.113 | −$0.002 | 0.1 ML | Inj gadoterate meglumi 0.1ml | v1, posted September 8, 2026 |
| 3Q25 | $0.115 | −$0.004 | 0.1 ML | Inj gadoterate meglumi 0.1ml | v1, posted March 10, 2026 |
| 2Q25 | $0.119 | +$0.002 | 0.1 ML | Inj gadoterate meglumi 0.1ml | v1, posted March 10, 2026 |
| 1Q25 | $0.117 | $0.00 | 0.1 ML | Inj gadoterate meglumi 0.1ml | v1, posted December 19, 2025 |
| 4Q24 | $0.117 | +$0.001 | 0.1 ML | Inj gadoterate meglumi 0.1ml | v1, posted June 11, 2025 |
| 3Q24 | $0.116 | −$0.006 | 0.1 ML | Inj gadoterate meglumi 0.1ml | v1, posted June 11, 2025 |
| 2Q24 | $0.122 | +$0.002 | 0.1 ML | Inj gadoterate meglumi 0.1ml | v1, posted March 11, 2025 |
| 1Q24 | $0.12 | −$0.003 | 0.1 ML | Inj gadoterate meglumi 0.1ml | v1, posted December 19, 2024 |
| 4Q23 | $0.123 | −$0.012 | 0.1 ML | Inj gadoterate meglumi 0.1ml | v1, posted October 10, 2024 |
| 3Q23 | $0.135 | −$0.034 | 0.1 ML | Inj gadoterate meglumi 0.1ml | v1, posted June 5, 2024 |
| 2Q23 | $0.169 | +$0.027 | 0.1 ML | Inj gadoterate meglumi 0.1ml | v1, posted February 23, 2024 |
| 1Q23 | $0.142 | −$0.001 | 0.1 ML | Inj gadoterate meglumi 0.1ml | v1, posted December 6, 2023 |
| 4Q22 | $0.143 | +$0.011 | 0.1 ML | Inj gadoterate meglumi 0.1ml | v1, posted June 22, 2023 |
| 3Q22 | $0.132 | −$0.021 | 0.1 ML | Inj gadoterate meglumi 0.1ml | v1, posted June 9, 2023 |
| 2Q22 | $0.153 | +$0.002 | 0.1 ML | Inj gadoterate meglumi 0.1ml | v1, posted December 14, 2022 |
| 1Q22 | $0.151 | −$0.009 | 0.1 ML | Inj gadoterate meglumi 0.1ml | v1, posted June 8, 2022 |
| 4Q21 | $0.16 | −$0.002 | 0.1 ML | Inj gadoterate meglumi 0.1ml | v1, posted June 2, 2022 |
| 3Q21 | $0.162 | $0.00 | 0.1 ML | Inj gadoterate meglumi 0.1ml | v1, posted June 2, 2022 |
| 2Q21 | $0.162 | −$0.005 | 0.1 ML | Inj gadoterate meglumi 0.1ml | v1, posted March 1, 2022 |
| 1Q21 | $0.167 | – | 0.1 ML | Inj gadoterate meglumi 0.1ml | v1, posted December 10, 2021 |
“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.
