Inj, leucovorin cal (avyxa)
Products billed under this code include Vykoura.
Payment limit per 1 MG, by effective quarter, 4Q26 to 4Q26. Gaps mean the code was not in that quarter’s file, or CMS gave no payment limit.Products billed under J0644
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 |
|---|---|---|---|---|
| Vykoura | Avyxa Pharma, LLC | 83831-0147-05 | 50 | $131.25 |
| Vykoura | Avyxa Pharma, LLC | 83831-0148-35 | 350 | $918.75 |
| Vykoura | Avyxa Pharma, LLC | 83831-0149-50 | 500 | $1,312.50 |
Every quarter
| Quarter | Payment limit | Change | Billing unit | Description | Source file |
|---|---|---|---|---|---|
| 4Q26 | $2.625 | – | 1 MG | Inj, leucovorin cal (avyxa) | v1, posted September 17, 2026 |
“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.
CMS source files
- 4Q26: 2026-09-17_october-2026-medicare-part-b-payment-limit-files-final.zipposted September 17, 2026
- 4Q26: 2026-09-17_october-2026-ndc-hcpcs-crosswalk-final.zipposted September 17, 2026